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Full text of "North Carolina Register v.6 no. 8 (7/15/1991)"

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NORTH CAROLINA 

REGISTER 



IN THIS ISSUE 



A 



TITU 
|TIOM 



EXECUTIVE ORDER 

PROPOSED RULES 

Environment, Health, and Natural Resources 

Human Resources 

Insurance 

FINAL RULES 

Human Resources 
List of Codified Rules 



ARRC OBJECTIONS 



RULES INVALIDATED BY JUDICIAL DECISION 



CEivte 



ISSUE DATE: JULY 15, 1991 
Volume 6 • Issue 8 • Pages 374-463 



INFORMATION ABOUT THE NORTH CAROLINA REGISTER AND ADMINISTRATIVE CODE 



NORTH CAROLINA REGISTER 

The North Carolina Register is published bi-monthly 
and contains information relating to agency, executive, 
legislative and judicial actions required by or affecting 
Chapter 150B of the General Statutes. All proposed, ad- 
ministrative rules and amendments filed under Chapter 
150B must be published in the Register. The Register 
will typically comprise approximately fifty pages per 
issue of legal text. 

State law requires that a copy of each issue be pro- 
vided free of charge to each county in the state and to 
various state officials and institutions. The North Carolina 
Register is available by yearly subscription at a cost of 
one hundred and five dollars ($105.00) for 24 issues. 

Requests for subscriptions to the North Carolina 
Register should be directed to the Office of Ad- 
ministrative Hearings, P. O. Drawer 27447, Raleigh, N. 
C. 27611-7447, Attn: Subscriptions. 

ADOPTION, AMENDMENT, AND REPEAL OF 
RULES 

An agency intending to adopt, amend, or repeal a rule 
must first publish notice of the proposed action in the 
North Carolina Register. The notice must include the 
time and place of the public hearing; a statement of how 
public comments may be submitted to the agency either 
at the hearing or otherwise; the text of the proposed 
rule or amendment; a reference to the Statutory 
Authority for the action and the proposed effective date. 

The Director of the Office of Administrative Hearings 
has authority to publish a summary, rather than the 
full text, of any amendment which is considered to be 
too lengthy. In such case, the full text of the rule con- 
taining the proposed amendment will be available for 
public inspection at the Rules Division of the Office of 
Administrative Hearings and at the office of the pro- 
mulgating agency. 

Unless a specific statute provides otherwise, at least 
30 days must elapse following publication of the pro- 
posal in the North Carolina Register before the agency 
may conduct the required public hearing and take ac- 
tion on the proposed adoption, amendment or repeal. 

When final action is taken, the promulgating agency 
must file any adopted or amended rule for approval by 
the Administrative Rules Review Commission. Upon ap- 
proval of ARRC, the adopted or amended rule must be 
filed with the Office of Administrative Hearings. If it 
differs substantially from the proposed form published 
as part of the public notice, upon request by the agen- 
cy, the adopted version will again be published in the 
North Carolina Register. 

A rule, or amended rule cannot become effective 
earlier than the first day of the second calendar month 
after the adoption is filed with the Office of Ad- 
ministrative Hearings for publication in the NCAC. 

Proposed action on rules may be withdrawn by the 
promulgating agency at any time before final action is 
taken by the agency. 

TEMPORARY RULES 

Under certain conditions of an emergency nature, 
some agencies may issue temporary rules. A temporary 
rule becomes effective when adopted and remains in 



effect for the period specified in the rule or 180 da 
whichever is less. An agency adopting a temporary n 
must begin normal rule-making procedures on the pi 
manent rule at the same time the temporary rule 
adopted. 

NORTH CAROLINA ADMINISTRATIVE CODE 

The North Carolina Administrative Code (NCAC) 
a compilation and index of the administrative rules 
25 state agencies and 38 occupational licensing boar 
The NCAC comprises approximately 15,000 letter si 
single spaced pages of material of which approxima 
ly 35% is changed annually. Compilation and publi 
tion of the NCAC is mandated by G.S. 150B-63(b) 

The Code is divided into Titles and Chapters. Ec 
state agency is assigned a separate title which is f 
ther broken down by chapters. Title 21 is designa 
for occupational licensing boards. 

The NCAC is available in two formats. 

(1) Single pages may be obtained at a minim: 
cost of two dollars and 50 cents ($2.50) for 
pages or less, plus fifteen cents ($0.15) per ej 
additional page. 

(2) The full publication consists of 53 volun 
totaling in excess of 15,000 pages. It is s 
plemented monthly with replacement page 
one year subscription to the full publication 
eluding supplements can be purchased 
seven hundred and fifty dollars ($750.00). 
dividual volumes may also be purchased w 
supplement service. Renewal subscriptions 
supplements to the initial publication availa 

Requests for pages of rules or volumes of the N( 
should be directed to the Office of Administra 
Hearings. 

NOTE 

The foregoing is a generalized statement of the \ 
cedures to be followed. For specific statutory langu 
it is suggested that Articles 2 and 5 of Chapter 1501 
the General Statutes be examined carefully. 

CITATION TO THE NORTH CAROLINA 
REGISTER 

The North Carolina Register is cited by volume, is 
page number and date. 1:1 NCR 101-201, April 1, 1 

refers to Volume 1, Issue 1, pages 101 through 20 
the North Carolina Register issued on April 1, 19 






North Carolina Register. Published bi-monthly by tl 
Office of Administrative Hearings, P.O. Drawer 2744 
Raleigh, North Carolina 27611-7447, pursuant i 
Chapter 150B of the General Statutes. Subscriptioi 
one hundred and five dollars ($105.00) per year. 
North Carolina Administrative Code. Published 
looseleaf notebooks with supplement service by tl 
Office of Administrative Hearings, P.O. Drawer 2744 
Raleigh, North Carolina 27611-7447, pursuant 
Chapter 150B of the General Satutes. Subscriptioi 
seven hundred and fifty dollars ($750.00). Individu 
volumes available. 



NORTH 
CAROLINA 
REGISTER 



ISSUE CONTENTS 



I. EXECUTIVE ORDER 

Executive Order 146... 



.374 




Office of Administrative Hearings 

P. O. Drawer 27447 

Raleigh, NC 27611-7447 

(919) 733 - 2678 



Julian Mann III, 

Director 
James R. ScarceUa Sr., 

Deputy Director 
Molly Masich, 

Director A PA Services 



Staff: 

Ruby Creech, 

Publications Coordinator 
Teresa KUpatrick, 

Editorial Assistant 
Jean Shirley, 

Editorial Assistant 



II. PROPOSED RULES 

Environment, Health, and 
Natural Resources 

Environmental Management. ...447 
Human Resources 

Aging, Division of 422 

Medical Assistance 430 

Mental Health, Developmental 
Disabilities and Subtance 

Abuse Services 375 

Insurance 
Life and Health Division 430 



III. PENAL RULES 

Human Resources 

Mental Health, Developmental 
Disabilities and Substance 

Abuse Services 449 

List of Rules Codified 451 

IV. ARRC OBJECTIONS 456 

V. RULES INVALIDATED BY 

JUDICIAL DECISION 460 

VI. CUMULATIVE INDEX 462 



' 



NORTH CAROLINA REGISTER 

Publication Schedule 

(April 1991 - December 1992) 



Issue 


Last Day 


Last Day 


Earliest 


* 


Date 


for 


for 


Date for 


Earliest 




Filing 


Electronic 


Public 


Effective 






Filing 


Hearing & 
Adoption by 
Agency 


Date 


******** 


******** 


******** 


******** 


*******< 


04/01 91 


03/11/91 


03/18/91 


05/01/91 


08/01/91 


04/15/91 


03/22/91 


04/01/91 


05/15/91 


08/01/91 


05/01/91 


04/10/91 


04/17/91 


05/31/91 


09/01/91 


05/15/91 


04/24/91 


05/01/91 


06/14/91 


09/01/91 


06/03/91 


05/10/91 


05/17/91 


07/03/91 


10/01/91 


06/14/91 


05/23/91 


05/31/91 


07/14/91 


10/01/91 


07/01/91 


06/10/91 


06/17/91 


07/31/91 


11/01/91 


07/15/91 


06/21/91 


06/28/91 


08/14/91 


11/01/91 


08/01/91 


07/11/91 


07/18/91 


08/31/91 


12/01/91 


08/15/91 


07/25/91 


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09/14/91 


12/01/91 


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08/12/91 


08/19/91 


10/03/91 


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08/30/91 


10/16/91 


01/01/92 


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09/10/91 


09/17/91 


10/31/91 


02/01/92 


10/15/91 


09/24/91 


10/01/91 


11/14/91 


02/01/92 


11/01/91 


10/11/91 


10/18/91 


12/01/91 


03/01/92 


11/15/91 


10/24/91 


10/31/91 


12/15/91 


03/01/92 


12/02/91 


11/07/91 


11/14/91 


01/01/92 


04/01/92 


12/16/91 


11/21/91 


12/02/91 


01/15/92 


04/01/92 


01/02/92 


12/09/91 


12/16/91 


01/31/92 


05/01/92 


01/15/92 


12/20/91 


12/31/91 


02/14/92 


05/01/92 


02/03/92 


01/10/92 


01/17/92 


03/04/92 


06/01/92 


02/14/92 


01/24/92 


01/31/92 


03/15/92 


06/01/92 


03/02/92 


02/10/92 


02/17/92 


04/01/92 


07/01/92 


03/16/92 


02/24/92 


03/02/92 


04/15/92 


07/01/92 


04/01/92 


03/11/92 


03/18/92 


05/01/92 


08/01/92 


04 15 92 


03/25/92 


04/01/92 


05/15/92 


08/01/92 


05/01/92 


04/10/92 


04/17/92 


05/31/92 


09/01/92 


05/15/92 


04/24/92 


05/01/92 


06/14/92 


09/01/92 


06/01/92 


05/11/92 


05/18/92 


07/01/92 


10/01/92 


06 15/92 


05/25/92 


06/01/92 


07/15/92 


10/01/92 


07/01/92 


06/10/92 


06/17/92 


07/31/92 


11/01/92 


07/15/92 


06/24/92 


07/01/92 


08/14/92 


11/01/92 


08/03/92 


07/13/92 


07/20/92 


09/02/92 


12/01/92 


08/14/92 


07/24/92 


07/31/92 


09/13/92 


12/01/92 


09/01/92 


08/11/92 


08/18/92 


10/01/92 


01/01/93 


09/ 1 5/92 


08/25/92 


09/01/92 


10/15/92 


01/01/93 


10/01/92 


09/10/92 


09/17/92 


10/31/92 


02/01/93 


10/15/92 


09/24/92 


10/01/92 


11/14/92 


02/01/93 


11/02/92 


10/12/92 


10/19/92 


12 (12 42 


03/01/93 


11/16/92 


10/23/92 


10/30/92 


12/16/92 


03/01/93 


12/01/92 


11/06/92 


11/13/92 


12/31/92 


04,01 93 


12/15/92 


11/24/92 


12/01/92 


01/14/93 


04/01/93 



* The "Earliest Effective Date" is computed assuming that the public hearing 
and adoption occur in the calendar month immediately following the "Issue 
Date", that the agency files the rule with The Administrative Rules Review 
Commission by the 20th of the same calendar month and that ARRC approves 
the rule at the next calendar month meeting. 



EXECUTIVE ORDER 



EXECUTIVE ORDER NUMBER 146 

SUPPLEMENTING EXECUTIVE ORDER NUMBER 145 

REALLOCATING THE COMMUNITY PENALTIES PROGRAM 

FROM THE DEPARTMENT OF CRIME CONTROL AND PUBLIC SAFETY 

TO THE DEPARTMENT OF CORRECTION 

Executive Order No. 145 shall not be implemented until further Executive Order signed by me. 

Done in the Capital City of Raleigh, North Carolina, this 28th day of June, 1991. 



6:8 NORTH CAROLINA REGISTER July 15, 1991 374 



PROPOSED RULES 



TITLE 10 - DEPARTMENT OF HUMAN 
RESOURCES 

Jyotice is hereby given in accordance with G.S. 
I SOB- 1 2 that the Commission for Mental Health, 
De\'elopmental Disabilities and Substance Abuse 
Services intends to amend rule(s) cited as 10 
NCAC 14K .0/03, .0312 - .0315, .0317, .0320, 
.0334, .0337, .0348, .0351, .0354; 14L .0407, 
.0506; 14M .0110, .0113, .0206, .0209, .0409 - 
.0410; I4N .0810; 140 .0105 - .0106, .0310, .0407 

- .0409; 181 .0120; 18L .0603, .0701 - .0702, 
.0806, .1102, .1502, .1507; 18M .0704, .0710, 
.0818, .1105, .1403, .1405; 18N .0212; 180 .0520 

- .0521, .0523; ISP .0903; 18Q .0541, .0808 - 
.0809; and repeal rule(s) cited as 10 NCAC 14K 
.0316. .0349; 14L .0309, .0507, .0607 - .0608, 
.0610. .0710; I4M .0208, .0210, .0613, .06/6; 140 
.0108 - .0109. .0207, .0410, .0610, .0616, .0619; 
18L .0505 - .0510, .0512, .0706, .0802, .1/04; 
18M .0308, .0W7; 18N .0307. 

1 he proposed effective date of this action is No- 
vember I, 1991. 

1 he public hearing will be conducted at 10:00 
a.m. on August 14, 1991 at the Mission Valley 
Inn. 3110 Avent Ferry Rd., Raleigh, NC 27606, 

(919) 828-3173. 

v_ omment Procedures: Any interested person 
may present his comments by oral presentation or 
by submitting a written statement. Persons wish- 
ing to make oral presentations should contact 
Marilyn Brothers, Division of Mental Health, De- 
velopmental Disabilities and Substance Abuse 
Services, 325 N. Salisbury St., Raleigh, NC 
27603, (919) 733-4774 by August 13, 1991. 
Written comments must be sent to the above ad- 
dress and must state the rule(s) to which the 
comments are addressed. Fiscal information on 
these rules is also available from the same address. 

CHAPTER 14 - MENTAL HEALTH: GENERAL 

SUBCHAPTER 14K - CORE LICENSURE RULES 

FOR MENTAL HEALTH: MENTAL 

RETARDATION AND OTHER 

DEVELOPMENTAL DISABILITIES: AND 

SUBSTANCE ABUSE FACILITIES 

SECTION .0100 - GENERAL INFORMATION 

.0103 DEFINITIONS 

(a) This Rule contains the definitions that ap- 
ply to all the rules in this Subchapter and Sub- 
chapters 14L through 140 of this Chapter. 



(b) In addition to the definitions contained in 
this Rule, the terms defined in G.S. 122C-3 also 
apply to all the rules in this Subchapter and 
Subchapters 14L through 140 of this Chapter. 

(c) The following terms shall have the 
meanings specified: 

(1) "Administering medication" means direct 
application of a drug to the body of a cli- 
ent by injection, inhalation, ingestion, or 
any other means. 

(2) "Adolescent" means a minor from 13 
through 17 years of age. 

(3) "Adult" means a person 18 years of age 
or older or a person under 18 years of age 
who has been married or who has been 
emancipated by a court of competent ju- 
risdiction or is a member of the armed 
forces. 

(4) "Aftercare" means those services provided 
to substance abuse clients after discharge 
from a service which facilitates the client's 
integration or reintegration into society. 
Activities may include self-help groups, 
supportive work programs and staff 
follow-up contacts and interventions. 

(5) "Alcohol abuse" means psychoactive 
substance abuse which is a residual cate- 
gory for noting maladaptive patterns of 
psychoactive substance use that have 
never met the criteria for dependence for 
that particular class of substance (criteria 
delineated in DSM-III-R published by the 
American Psvchiatric Association, 1400 
K Street, N.W., Washington, D.C. 20005 
at a cost of twenty-nine dollars and 
ninety-five cents ( $29.95] for the soft 
cover edition and thirty-nine dollars and 
ninety-five cents ($39.95) for the hard 
cover edition.) 

(6) "Alcohol dependence" means 
psychoactive substance dependence which 
is a cluster of cognitive behavioral, and 
physiologic symptoms that indicate that a 
person has impaired control of 
psychoactive substance use and continues 
use of the substance despite adverse con- 
sequences (criteria delineated in 
DSM-III-R published by the American 
Psvchiatric Association, 1400 K Street, 
N.W., Washington, D.C. 20005 at a cost 
of twenty-nine dollars and ninety-five 
cents ($29.95) for the soft cover edition 
and thirty-nine dollars and ninety-five 
cents ($39.95) for the hard cover edition.) 

(7) "Applicant" means any person who in- 
tends to establish, maintain or operate a 
licensable facility and who applies to the 
Department for a license to operate a fa- 



375 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



cility under the provisions of G.S. 122C, 
Article 2. 

(8) "Approved supported employment con- 
version plan" means a planned approach 
to changing the type of services delivered 
from ADAP facility-based to supported 
employment. Approval of the conversion 
plan is the responsibility of the Regional 
Director of the Division and the Area Di- 
rector or his designee if the facility is op- 
erated by a contract agency of the area 
program or other service provider. The 
Division shall request appropriate per- 
sonnel from the Division of Vocational 
Rehabilitation to participate in the review 
process. The request for approval of the 
supported employment conversion plan 
shall include specific written information 
in the following areas: 

(A) number of clients to be moved into 
supported employment placements; 

(B) types of supported employment models 
to be used; 

(C) timeframe for the conversion period; 

(D) interim proposed facility staffing pat- 
terns and responsibilities; and 

(E) proposed budget for conversion plan. 

(9) "Area program" means a legally consti- 
tuted public agency providing mental 
health, mental retardation and substance 
abuse services for a catchment area desig- 
nated by the Commission. For purposes 
of these Rules, the term "area program" 
means the same as "area authority" as 
defined in G.S. 122C-3. 

(10) "Assessment" means a procedure for de- 
termining the nature and extent of the 
problem for which the individual is seek- 
ing service. 

(11) "Atypical development" in children 
means those from birth to 60 months of 
age who demonstrate significantly atypical 
behavioral socioemotional, motor, or 
sensory development as manifested by: 

(A) Diagnosed hyperactivity, attention def- 
icit disorder or other behavioral disorders, 
or 

(B) Identified emotional or behavioral dis- 
orders such as: 

(i) delay or abnormality in achieving ex- 
pected emotional milestones, such as 
pleasurable interest in adults and peers; 
ability to communicate emotional 
needs; and ability to tolerate frus- 
trations. 

(ii) persistent failure to initiate or respond 
to most social interactions. 



(iii) fearfulness or other distress that does 
not respond to comforting by 
caregivers. 

(iv) indiscriminate sociability, e.g. exces- 
sive familiarity with relative strangers. 

(v) self-injurious or unusually aggressive 
behavior, or 
(C) Substantiated physical abuse, sexual 

abuse, or other environmental situations 

that raise significant concern regarding the 

child's emotional well-being. 

(12) "Certified counselor" means an 
alcoholism, drug abuse or substance abuse 
counselor who is certified by the North 
Carolina Substance Abuse Professional 
Certification Board. 

(13) "Child" means a minor from birth 
through 12 years of age. 

(14) "Chronically mentally ill adult" means 
an individual 18 years of age or older who, 
as a result of a mental disorder, exhibits 
emotional or behavioral functioning 
which is so impaired as to interfere sub- 
stantially with his capacity to remain in 
the community without supportive treat- 
ment or services of a long-term or indefi- 
nite duration. In these persons, mental 
disability is severe and persistent, resulting 
in long-term limitation of their functional 
capacities for primary activities of daily 
living such as interpersonal relations, 
homemaking, self-care, employment and 
recreation. 

( 1 5) "Client record" means a written account 
of all services provided a client from the 
time of formal acceptance? admission of 
the client by the facility until termination 
ef oorvicoG. This information is docu 
montod ©«■ standard forms adopted by the 
facility which we fik4 i» a standard order. 
discharge from the facility. 

(16) "Clinical" means having to do with the 
active direct treatment habilitation of a 
client. 

(17) "Clinical staff member" means a profes- 
sional who provides active direct 
treatment habilitation to a client. 

(18) "Clinical/professional supervision" 
means regularly scheduled assistance by a 
qualified mental health professional, a 
qualified substance abuse professional or 
a qualified developmental disabilities pro- 
fessional to a staff member who is pro- 
viding direct, therapeutic intervention to 
a client or clients. The purpose of clinical 
supervision is to ensure that each client 
receives appropriate treatment or habili- 
tation which is consistent with accepted 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



376 



PROPOSED RULES 



standards of practice and the needs of the 
client. 

(19) "Contested case" means an administra- 
tive proceeding under G.S. 150B, Article 
3, in which the rights, privileges, or duties 
of a party are required by law to be de- 
termined. 

(20) "Contract agency" means a legally con- 
stituted entity with which the area pro- 
gram contracts for a service exclusive of 
intermittent purchase of service for an in- 
dividually identified client. 

(21) "Day night service" means a service 
provided on a regular basis, in a structured 
environment that is offered to the same 
individual for a period of three or more 
hours within a 24-hour period. 

(22) (34} "Declarator)' ruling" means a formal 
and binding interpretation as to: 

(A) the validity of a rule; or 

(B) the applicability to a given state of facts 
of a statute administered by the Depart- 
ment of Human Resources, or a rule or 
order of the Department of Human Re- 
sources. 

(23) (33) "Detoxification" means the physical 
withdrawal of an individual from alcohol 
or other drugs in order that the individual 
can participate in rehabilitation activities. 

(24) (-33} " Developmental! y delayed children" 
means those whose development is de- 
layed in one or more of the following 
areas: cognitive development, physical de- 
velopment, language or speech, self-help 
and psychosocial skills. The specific level 
of delay must be: 

(A) for children from birth to 36 months 
of age, documented by scores 1 V% stand- 
ard deviations below the mean on stand- 
ardized tests in at least one of the above 
areas of development. Or, it may be 
documented by a 20 percent delay on as- 
sessment instruments that yield scores in 
months; and 

(B) for children from 36 to 60 months of 
age, documented by test performance two 
standardized deviations below the mean 
on standardized tests in one area of de- 
velopment or by performance that is one 
standard deviation below the norm in two 
areas of development. Or, it may be 
documented by a 25 percent delay in two 
areas on assessment instruments that yield 
scores in months. 

(25) (34} "DFS" means the Division of Facil- 
ity Services, 701 Barbour Drive, Raleigh, 
N.C. 27603. 



(26) f3£) "Direct care staff' means an individ- 
ual who provides active direct care, treat- 
ment, or rehabilitation or habitation 
services to clients. e» a continuous a«4 
regularly sch e dul e d baric 

(27) (36) "Dispensing medication" means pre- 
paring and packaging a prescription drug 
or device in a container and labeling the 
container with information required by 
state and federal law. Filling or refilling 
drug containers with prescription drugs 
for subsequent use by a client is "dis- 
pensing". Providing quantities of unit 
dose prescription drugs for subsequent 
administration is "dispensing". 

(28) (35) "DMH.MR SAS" "DM11 DP/ 
SAS" means the Division of Mental 
Health, Mental Retardation Develop- 
mental Disabilities, and Substance Abuse 
Services, 325 N. Salisbury Street, Raleigh, 
N.C. 3?444t 27603. 

(29) (38) "Documentation" means provision 
of written, dated and authenticated evi- 
dence of the deliven' of client services or 
compliance with statutes or rules, e.g., 
entries in the client record, policies and 
procedures, minutes of meetings, memo- 
randa, reports, schedules, notices and an- 
nouncements. 

(30) (30} "Drug abuse" means psychoactive 
substance abuse which is a residual cate- 
gory for noting maladaptive patterns of 
psychoactive substance use that have 
never met the criteria for dependence for 
that particular class of substance (criteria 
delineated in DSM-III-R published by the 
American Psychiatric Association, 1400 
K Street, N.W., Washington, DC. 20005 
at a cost of twenty-nine dollars and 
ninety-five cents ($29.95) for the soft 
cover edition and thirty-nine dollars and 
ninety-five cents ($39.95) for the hard 
cover edition.) 

(31) (40} "Drug dependence" means 
psychoactive substance dependence which 
is a cluster of cognitive behavioral, and 
physiologic symptoms that indicate that a 
person has unpaired control of 
psychoactive substance use and continues 
use of the substance despite adverse con- 
sequences (criteria delineated in 
DSM-III-R published by the American 
Psychiatric Association, 1400 K Street, 
N.W., Washington, D.C. 20005 at a cost 
of twenty-nine dollars and ninety-five 
cents ($29.95) for the soft cover edition 
and thirty-nine dollars and ninety-five 
cents ($39.95) for the hard cover edition.) 



377 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



(32) (44) "DVVI" means driving while im- 
paired, as denned in G.S. 20-138.1. 

(33) (42) "DWI substance abuse assessment" 
means a service provided to persons 
charged with or convicted of DWI to de- 
termine the presence of chemical depend- 
ency. The "assessment" involves a 
face-to-face interview with a substance 
abuse professional. 

(34) f44} "Early Intervention Services" means 
those services provided for infants and 
toddlers specified in Section 303.12 of 
Subpart A of Part 303 of Title 34 of the 
Code of Federal Regulations. This 
adoption by reference is in accordance 
with G.S. 150B- 14(c). 

(35) (44) "Evaluation" means an assessment 
service which identifies the nature and ex- 
tent of an individual's problem through a 
systematic appraisal for the purposes of 
diagnosis and determination of the disa- 
bility of the individual and the most ap- 
propriate plan, if any, for services. Such 
appraisal shall inoludo efie ef more ef the 
following: montal, phyoical, behavioral, 
functional, social, economic ae4 intolloc 
teal resourc e s ef the individual. 

(36) (444. "First aid" means emergency treat- 
ment for injury' or sudden illness before 
regular medical care is available. First aid 
includes artificial respiration, the Heimlich 
maneuver, or other Red Cross first aid 
techniques for relieving airway ob- 
struction, care of wounds and burns, and 
temporary administering of splints. 

(37) (46) "Governing body" means those per- 
sons who by law, charter, articles of in- 
corporation, partnership agreement, or 
other legally recognized manner have full 
legal authority for the overall operation 
of the facility. 

(38) (44) "Health Services" means those ser- 
vices provided for infants and toddlers 
specified in Section 303.13 of Subpart A 
of Part 303 of Title 34 of the Code of 
Federal Regulations. This adoption by 
reference is in accordance with G.S. 
150B- 14(c). 

(39) (4*) "Hearing" means, unless otherwise 
specified, a contested case hearing under 
G.S. 150B, Article 3. 

(40) (49) "High risk children" means those 
from birth to 36 months of age who: 

(A) have a diagnosed physical or mental 
condition which has a high probability of 
resulting in developmental delay or atypi- 
cal development; 



(B) have significant atypical patterns of de- 
velopment (perceptual, sensory, physical, 
behavioral, motor anomalies) that have a 
high probability of resulting in develop- 
mental delay or atypical development; or 

(C) have responded well to intervention ef- 
forts but for whom there is evidenced that 
their continued developmental progress 
cannot be assured without continued 
intervention. 

(41) (40) "Hours of operation" means an indi- 
cation of the minimum operational hours 
that a service is expected to be available 
to clients, but not prohibiting the typical 
closing of a service to accommodate holi- 
days, vacations, staff development activ- 
ities and weather and facility-related 
conditions but taking into consideration 
the type of service being provided. 

(42) (44) "ICF/MR" (Intermediate Care 
Facility/ Mentally Retarded) means a fa- 
cility certified as having met federal 
ICF/MR requirements and which pro- 
vides 24-hour personal care, habilitation, 
developmental and supportive services to 
persons with mental retardation or related 
conditions. 

(43) (44) "Incident" means any happening 
which is not consistent with the routine 
operation of the facility or the routine care 
of a client and that is likely to lead to ad- 
verse effects upon a client. 

(44) "Individual goal plan" (fef clients with 

Q^^^J^^^^^ *-J^^r^^^^^«l ^^JI f it I 1 ^ F I 1 I M ,1 , jTM II > r ^ fr • i [ 

I I IV I 1 1AII I LTIU VIVI 1 1\ 7 I 1 1.' I I } I I IV I \J\. ? PRRTinOIn 111 

disabilities) moans a written plan which 
includos moasurablo, dato specific, short 
rango objectives which m assossod a»4 
devolopod ef r e stated at least quart e rly 
based e» the strengths an4 needs ef the 
client ae4 which identifies specific staff 
responsibilities ae4 relates te the annual 
individual program plan. 
(44) "Individual program plan" (fef clients 
with montal retardation ef other dovolop 
montal disabilities) which is som e tim e s 
referred te as a» "habilitation plan," 
moans a written plan which includos 
long rang e objectives fef the client based 
e» evaluations, observations ati4 othor 
client assessment eate ae4 which is ifH- 
plomontod following admission ef the eh- 
efttr ae4 assossod a«4 redeveloped at least 

UI 11 IUUI I ▼ ITTTTTT 1 1 TV UUIV CrI 1'IUWI I IV 1 1 1 - I 1 IV 

individual program elae includos a written 
summary ef the client's progress regarding 
previous program plans. 
(44) "Individual treatment plan" (fef mental 
health a«4 substance abuse clients) means 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



378 



PROPOSED RULES 



(44) 
(45) 

(46) 
till 



(49) 

(50) 

(51) 

(52) 
(53) 

(54) 
(5: 



a plan fo treatment fof fo<* client. ¥ke 
plan contains time specific short affo long 
term goals a«4 strategi e s fof implementing 
foe goals, aft4 id e ntifies direct eafe steff 
responsibl e fof foe provision ef- troatmont 
affo rohabilitation services te- foe client . 
44*e individual treatment plan » synony 
moui with foe individual sep . ice plan. 
(4fo "Infant" means an individual from 
birth through two years of age. 
(4?) "Legend drug" means a drug that 
cannot be dispensed without a pre- 
scription. 

f4&) "License" means a permit to operate 
a facility which is issued by DFS under 
G.S. 122C, Article 2. 

(-4£) "Medication" means a substance re- 
cognized in the official "United States 
Pharmacopoeia" or "National 

Formulary" intended for use in the diag- 
nosis, mitigation, treatment or prevention 
of disease. 

(4fo "Minor client" means a person under 
1 8 years of age who has not been married 
or who has not been emancipated by a 
decree issued by a court of competent ju- 
risdiction or is not a member of the armed 
forces. 

fo44 "Neighborhood" - See "residential 
setting". 

£§3) "Nurse" means a person licensed to 
practice in the State of North Carolina 
either as a registered nurse or as a licensed 
practical nurse. 

fo^4 "Operator" means the designated 
agent of the governing body who is re- 
sponsible for the management of a 
licensable facility. 

"Outpatient" or "Outpatient sen ice" 
niiviih the midl' as periodic sen ice. 
fo44 "Parent" means the biological or 
adoptive mother or father of a minor cli- 
ent or person who has been appointed to 
serve as a surrogate parent. 
"Periodic senice" means a sen'ice pro- 



vided through short, recurring visits for 
persons who are mentally ill, develop- 
mentallv disabled or substance abusers. 



(56) 



"Physical examination" means the pro- 
cedures used by a physician or physician 
extender on behalf of a physician to de- 
termine the physiological and anatomical 
condition of the client. Physical exam- 
ination also means medical examination. 

"Physician extender" means a nurse 
practitioner or a physician assistant ap- 
proved to perform medical acts by the 



Board of Medical Examiners of the State 
of North Carolina. 

(57) "Preschool age child" means a child from 
three through five years of age. 

(58) "Private facility" means a facility not 
operated by or under contract with an 
area program. 

(59) "Program evaluation" means the sys- 
tematic documented assessment of pro- 
gram activity to determine the 
effectiveness, efficiency and scope of the 
system under investigation, to define its 
strengths and weaknesses and thereby to 
provide a basis for informed decision- 
making. 

(60) "Provider" means an individual, agency 
or organization that provides mental 
health, mental retardation or substance 
abuse senices. 

(61) "Psychiatric nurse" means an individual 
who is licensed to practice as a registered 
nurse in the State of North Carolina by 
the North Carolina Board of Nursing and 
who is a graduate of an accredited mas- 
ter's level program in psychiatric mental 
health nursing with two years of experi- 
ence, or has a master's degree in behav- 
ioral science with two years of supenised 
clinical experience, or has four years of 
experience in psychiatric mental health 
nursing. 

(62) "Psychiatric social worker" means an in- 
dividual who holds a master's degree in 
social work from an accredited school of 
social work and has two years of clinical 
social work experience. 

(63) "Psychiatrist" means an individual who 
is licensed to practice medicine in the 
State of North Carolina and who has 
completed an accredited training program 
in psychiatry. 

(64) "Psychotherapy" means a form of treat- 
ment of mental illness or emotional dis- 
orders which is based primarily upon 
verbal or non-verbal communication with 
the patient. Treatment is provided by a 
trained professional for the purpose of re- 
moving or modifying existing symptoms, 
of attenuating or reversing disturbed pat- 
terns of behavior, and of promoting posi- 
tive personality growth and development. 

(65) "Psychotropic medication" means 
medication with the primary function of 
treating mental illness or personality or 
behavior disorders. These medications 
include, but are not limited to, antipsy- 
chotics, antidepressants, neuroleptics, 
lithium and minor tranquilizers. 



379 



6:8 NORTH CAROLINA REGISTER July 15, 1 99 1 



PROPOSED RULES 



(66) "Qualified alcoholism professional" 
means an individual who is certified by 
the North Carolina Substance Abuse 
Professional Certification Board or who 
is a graduate of a college or university with 
a baccalaureate or advanced degree in a 
human service related field with doc- 
umentation of at least two years of super- 
vised experience in the profession of 
alcoholism counseling. 

(67) "Qualified developmental disabilities 
professional" means an individual holding 
at least a baccalaureate degree in a disci- 
pline related to developmental disabilities, 
and at least two years of supervised 
habilitative experience in working with the 
mentally retarded or otherwise develop- 
mentally disabled or holding a 
baccalaureate degree in a field other than 
one related to developmental disabilities 
and having three years of supervised ex- 
perience in working with the mentally re- 
tarded or otherwise developmentally 
disabled. 

(68) "Qualified drug abuse professional" 
means an individual who is certified by 
the North Carolina Substance Abuse 
Professional Certification Board or who 
is a graduate of a college or university with 
a baccalaureate or advanced degree in a 
human service related field with doc- 
umentation of at least two years of super- 
vised experience in the profession of drug 
abuse counseling. 

(69) "Qualified mental health professional" 
means any one of the following: psychia- 
trist, psychiatric nurse, practicing psy- 
chologist, psychiatric social worker, an 
individual with at least a master's degree 
in a related human service field and two 
years of supervised clinical experience in 
mental health services or an individual 
with a baccalaureate degree in a related 
human service field and four years of 
supervised clinical experience in mental 
health services. 

(70) "Qualified nutritionist" means an indi- 
vidual who has a Master's degree in nu- 
trition, nutrition education or public 
health nutrition and who may or may not 
be a registered dietitian. 

(71) "Qualified substance abuse professional" 
means an individual who is: 

(A) certified by the North Carolina Sub- 
stance Abuse Professional Certification 
Board; or 

(B) a graduate of a college or university 
with a baccalaureate or advanced degree 



in a human service related field with doc- 
umentation of at least two years of super- 
vised experience in the profession of 
alcoholism and drug abuse counseling. 

(72) "Registered dietitian" means an individ- 
ual who has successfully completed a na- 
tional examination for the Commission 
on Dietetic Registration and maintains 
registration with that commission through 
approved continuing education activities 
and events. 

(73) "Rehabilitation" means training, care and 
specialized therapies undertaken to assist 
a client to reacquire or maximize any or 
all lost skills or functional abilities. 

(74) "Research" means inquiry involving a 
trial or special observation made under 
conditions determined by the investigator 
to confirm or disprove an hypothesis, or 
to explicate some principle or effect. The 
term "research" as used in this document 
means research which is not standard or 
conventional; involves a trial or special 
observation which would place the subject 
at risk for injury' (physical, psychological 
or social injury), or increase the chance 
of disclosure of treatment; utilizes ele- 
ments or steps not ordinarily employed 
by qualified professionals treating similar 
disorders of this population; or is a type 
of procedure that serves the purpose of 
the research only and does not include 
treatment designed primarily to benefit the 
individual. 

(75) "Residential setting" means a living area 
or zone in which the primary purpose is 
family residential living and which may 
be located in an area zoned either urban 
residential or rural. 

(76) "Respite discharge" means that point in 
time when no additional incidents of re- 
spite services are anticipated. aft4 the e&- 
e»t- record is cloiiod. 

(77) "Respite episode" means an uninter- 
rupted period of time during which a cli- 
ent receives respite services. T-he gpioodo 

*->-» «-» < • 1 "t n r i r-i Ia.iMU t «-,-\ *-»-i r^. *-> ."> h ri i i f rt r- I . ^ e .- 
I HUT Till T TTT in lE^lII rTTTTTT \J\ 1^ 11LJ Lll LTI IV. J.J 

te »«* month. 

(78) "Screening" means an assessment service 
which provides for a brief faco to fac e ap- 
praisal of each individual who presents 
himself for services, in order to determine 
the nature of the individual's problem and 
his need for services. Screening may also 
include referral to other appropriate com- 
munity resources. 

(79) "Secretary" means the Secretary of the 
Department as defined in G.S. 122C-3. 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



380 



PROPOSED RULES 



(80) "Sen ice" means an activity or interaction 
intended to benefit another, with, or in 
behalf of an individual who is in need of 
assistance, care, habilitation, intervention. 



rehabilitation or treatment. 



(81) frS©^ "Severely physically disabled 
person" means for the purpose of ADAP 
(Adult Developmental Activity Program) 
a person: 

(A) who has a severe physical disability 
which seriously limits his functional ca- 
pabilities (mobility, communication, self- 
care, self-direction, work tolerance or 
work skills); 

(B) who has one or more physical disabili- 
ties resulting from amputation, arthritis, 
blindness, cancer, cerebral palsy, cystic 
fibrosis, deafness, heart disease, 
hemiplegia, hemophilia, respiratory or 
pulmonary dysfunction, multiple sclerosis, 
muscular distrophy, musculoskeletal dis- 
orders, neurological disorders (including 
stroke and epilepsy), paraplegia, 
quadriplegia, and other spinal cord condi- 
tions, sickle cell anemia and end stage 
renal disease; and 

(C) whose habilitation or rehabilitation can 
be expected to require multiple habili- 
tation or rehabilitation services over an 
extended period of time. 

(82) (-8-H "Sheltered employment" means a fa- 
cility's provision of work and work train- 
ing by: 

(A) subcontracting from industries in the 
community and bringing work to the fa- 
cility to be performed; or 

(B) manufacturing its own products in the 
facility. 

Clients served in a sheltered employment 
model are those who consistently achieve 
earning levels exceeding one-half of the 
minimum wage but who are not ready for 
independent employment activities. 

(83) f£34 "Staff member" means any individual 
who is employed by the facility. 

(84) {$r^f "Substantially mentally retarded per- 
son" means for the purpose of ADAP a 
person who is mentally retarded to the 
degree of seriously limiting his functional 
capabilities, whose habilitation or rehabil- 
itation can be expected to extend over a 
period of time, and including: 

(A) moderately mentally retarded persons; 

(B) severely mentally retarded persons; 

(C) profoundly mentally retarded persons; 
or 

(D) mentally retarded persons with a 
handicapping condition so severe as to 



lack the potential for employment at this 
time, either in a sheltered or competitive 
setting. In addition, such individuals 
must have a deficit in self-help, commu- 
nication, socialization or occupational 
skills and be recommended by the voca- 
tional rehabilitation counselor for consid- 
eration of placement in an ADAP. 

(85) (£44 "Support services" means services 
provided to enhance an individual's 
progress in his primary 
treatment/habilitation program. 

(86) f84) "Supported employment" means a 
day/night service which involves paid 
work in a job which would otherwise be 
done by a non-disabled worker. Sup- 
ported employment is carried out in an 
integrated work site where a small number 
of people with disabilities work together 
and where the work site is not imme- 
diately adjacent to another program serv- 
ing persons with disabilities. It includes 
intensive involvement of staff working 
with the individuals in these integrated 
settings. 

(87) (£6) "Toddler" means an individual from 
one through three years of age. 

(88) (-&?} "Treatment" means the process of 
providing for the physical, emotional, 
psychological and social needs of clients 
through services. 

(89) "Treatment habilitation plan" means a 
plan in which one or more privileged 
professionals, working with the client and 
in some cases family members or other 
service providers, document which inter- 
ventions will be provided and the goals, 
objectives and strategies that will be fol- 
lowed in providing services to the client. 

(90) (£&> "Twenty-four hour facility in which 
medical care is an integral component" 
means a facility in which: 

(A) the medication needs of clients may be 
evaluated, medication prescribed and lab- 
oratory tests ordered to assist in the diag- 
nosis, treatment and monitoring of 
problems associated with the mental 
health, mental retardation or other devel- 
opmental disabilities or substance abuse 
disorder of clients; and 

(B) proper referral of the client is made to 
medical specialists when needed. 

(91) "Twcntv-four hour service" means a ser- 
vice which is provided to a client on a 
24-hour continuous basis. 

Statutory Authority G.S. I22C-3; I22C-26; 
/43B-I47. 



3S1 



6:8 NORTH CAROLINA REGISTER July 15, 1 99 1 



PROPOSED RULES 



SECTION .0300 - FACILITY AND PROGRAM 
MANAGEMENT 

.0312 SCREENING 

(a) The governing body shall develop and im- 
plement written screening policies establishing a 
systematic means of screening determining each 
individual's need for services, et wh e th e r he shall 
be referred to another oorvioo. 

(b) The policy policies shall designate who is 
deemed qualified specify the qualifications, based 
on education and experience, to of persons who 
may make screening determinations. 

(c) When possible and appropriate, and with 
client consent, family members or other persons 
significantly involved with the client's life client 
shall be encouraged to participate in the screen- 
ing of the client. 

(d) Screening shall include the following: 

( 1) an assessment of the Individual individual's 

presenting problems related to toe services 
offered by- toe facility; aftd problem or 
need; 

(2) disposition (referrals a»d recommon 
dations). an assessment of whether or not 
the facility can provide services to address 
the individual's needs; and 

(3) the disposition, including referrals and 
recommendations. 

Statutory Authority G.S. I22C-26; I43B-147. 

.0313 ADMISSION AND DISCHARGE 

(a} The governing body shall develop and im- 
plement written admission policies a»d proc e 
dures for each facility which shall include at- least 
regarding the following: 

( 1) criteria for admission; 

(2) criteria for discharge, which . in 24 hour fa- 
cilities, shall be consistent with G.S. 
122C-61; and 

(3) referrals and transfers. 

(44, designation ef staff who are doomed qual 
ifred to admit clients; 

(3) admission criteria; 

(34 procedures fof compliance with Article § 
ef Chapter 122C ef toe N.C. G e neral 
Statutes, Parts 3r 4\ 4y &j 7 a»d & as appli 
cable; aftd 

(4) » residential facilities, except fof respite 
services, requirements fof a» agreement 
between toe facility aed toe cli e nt ef hi* 
l e gally responsible person which shall de- 
hneate toe responsibilities ef both parties 
fof toe provision ef medical aftd dental 
services, education aft4 other needs. 



(te4 Jtof voluntary admissions eaeff application 
fof admission aftd consent fof 

treatment habilitation shall be signed by toe eli- 
e»t- ef legally r e sponsible person upon admission 
to a facility, Fef involuntary admissions, doc 
umontation ef toe commitment process shall be 
maintained by toe facility. 

Statutory Authority G.S. 122C-26; 143B-I47. 

.0314 ASSESSMENT 

(a) The governing body shall develop and im- 
plement written policies a»d procedures relative 
to assessment requirements fof individuals served 
by toe regarding admission assessments for cli- 
ents in each facility. 
(b4 Mental Health Facilities: 
(-4} Inpati e nt psychiatric; residential acute 
treatm e nt; partial hospitalisation; resid e n 
toil treatment fof children a»d youth; affo 
day- treatment facilities fof children aftd- 
youth shall complete: 
(A) A» individual admission assessment 
within 54 hours ef admission, mental sto- 
tosr admitting diagnosis, a»d d e termi 
nation ef need fof additional information, 
diagnostic t e sts ef e valuations; 

within 73 hours ef admission; a»d 
(£4 Current social, medical, psychiatric, 
educational a»d vocational histories aed- 
assessments such as substance abuse, de- 
velopmental, legal, nutritional, eto^ com 
pleted ef obtained within 40 days if 
appropriate. 
(-34 Psychosocial r e habilitation programs aftd 
group homes fof adult aftd elderly clients 
shall complete aft admission not e within 
34 hours fof each client who is admitted 
to toe facility. 44*e admission note shall 
include toe present condition ef toe client 
r e port e d to objectiv e , behavioral terms; 
toe name ef toe mental health profes 
sional who is responsible fof toe treatment 
aftd ease management ef toe client; aftd 
toe reason fof admission. 
(e) Developmental Disabilities Facilities aftd- 
Sheltered Workshops: 

(44 Within 4e days following admission, toe 
following assessment information shall be 
completed: 
(A4 toe pres e nt condition ef toe client fe- 
ported to objectiv e , behavioral terms, aed- 
wher e possibl e a description ef toe client's 
condition by- family members. -Pet aH fa- 
ciliti e s serving infants, toddlers aftd pfe- 
school age children, except thos e 
providing respite sen ices, toe assessment 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



3S2 



PROPOSED RULES 



of levels of physical, including vision a»4 
hearing, language a»4 speech, oognitivo, 
psychosocial a»4 self help skills develop 
ment r . hall be completed. There ohali be 
a determination of the child's unique 
needs ift terms of these areas of develop 
ment aoo. identification of services appro 
priat e to meet thos e needs. Also, foF aH 
facilities s e rving infants, toddlers aft4 
preschoolers except foF respite, the assess 
ment process shall include, if the family 

t»4 needs of the family related to eft- 
hancing the development of the child. 
4be family focused assessment shall he 
based oo information provided through a 
personal interview an4 incorporate the 
family's description of the strengths a»4 
needs, 44*e assessment process shall io- 
clud e proc e dur e s £of ensuring partic 
ipation by the client's family of the l e gally 
responsible person; 

(44+ social, developmental *h4 medical his- 
torios a»4 assessm e nts. Additional histo 
pies a«4 assessments shall be completed 
as appropriate (e.g., vocational, psychiat 
BOr l e gal, e ducational aoo nutritional). 
Histories ao4 assessments generated by- 
other facilities of service providers may be 
used £of respite programs; 

fG} determination ofr aoo requ e st foFr ao- 
ditional referrals foF special diagnostic 
tests, assessments of evaluations, if 
needed; 

(44+ results of oth e r standardized ao4 non 
standardised evaluations ift the areas 
identified » (c)(1)(B) of this R.ulc; 

(444 summary of client aftdr if appropriate, 
family strengths a»4 weaknesses; 

fF+ copies of relevant evaluations from 
other agenci e s of service providers. 
(3) A» ADAP which operates within a shel 
tered workshop that meets the require 
ments of the Division of Vocational 
Rehabilitation S e rvices shall be considered 
to have a» approved ADAP evaluation 
program which Fftay provide the lnforma 
t+oft foF the evaluation report. 
f44 r>*o more than 40 days prior to admission 
to a facility, a medical assessment shall be 
completed indicating the client's ability to 
participate ift the program, presence of a 
communicable disease of a communicable 
condition that presents a significant fish- 
£of transmission within the facility, aa4 
compliance with the immunization Fe- 
quir e ments ift Gt&t 130A 153. ff the eh- 
e»t ha* specific medical problems, the 



physician's assessment shall include a 
written statement regarding managem e nt 
of the client, including control m e asures 
required £of communicabl e diseases aft4 
conditions by GtSt 130A Ml. 44*e ohy- 
sician's assessment shall be updated at 
least annually during the client's place 
ment » the facility except foF ADAP, af- 
tornative family living aoo supervised 
independent living. 
(4+ Pof all facilities serving infants, toddlers 
a»4 preschoolers except foF respite: 

/Ai t^^ti^ O " Q ''*''■"• .11 ill i ; i t i , ^ fi r-r-i ■ i t 1 1 j-i 'i 1 P ■-! n ,~\ 

\ 1 1 J IKJJU HI IU \.Jl 1 1\. I L. I U1UUL H.-'I I 1 1 J U I L'l 1LUJ til ITJ 

procedures shall be administered » the 
nativ e language of the parents of other 
mode of communication unless it is 
cl e arly Ftot f e asible to do sot 
(44} afty assessment procedures a»4 matori 
als that are used afe selected a»4 adminis 
tered so as ftot to be racially of culturally 
discriminatory; 

it \ 11 l-L CA«iiil^ ||| , I. ,, , I I I .l C P 'ill ' . i ll£Q^I <t B *JT^ 

sole criterion foF determining a child's eJ- 
igibihty under this part; 

(44+ assessm e nts shall be carried oot by 
professionals privileged according to pro 
ceduros outlined i» the Division's publi 
cation, "REGl I ATIONS POR- 

PRIVILEGING PROFESSIONALS 
WORKING WITH INFANTS A4vD 
TODDLERS W¥fU OR A¥ iUSfe EQR 
DEVELOPMENTAL DELAY Gft- 
ATYPICAL DEVELOPMENT", APSM 
+0©-4 (01 , 01 , 80) of comparable proce 
dures approved by the Division; 

(44+ the assessment process shall be a 
multidisciplinapy o»e aft4 reflect the ift- 
volvement of two of more disciplines of 
professions with the sp e cific number a»4 
typos of disciplines determin e4 by the 
needs of the particular child: 

fp+ the evaluation process must be based 
oft informed clinical opinion; 

(-G+ the assessment process shall be com 
ploted within 44 cal e ndar days from the 
date of referral: af*4 

(44) the child's family of legally responsible 
person shall be fully inform e d of the Fe- 
sults of the ass e ssm e nt proc e ss. 
f44 Substance Abuse Facilities: 
(44 Substanc e abuse facilities, with the excep 
tioft of supervis e d indep e ndent living, aJ- 
ternative family living aod- halfway houses, 
shall conduct a» assessment of the client 
after admission as follows: 

( A \ -1 , i r-n i^rii-in ■-■ .- ■- Q . . ■ m .-int t , ^ p Q a . -\ «-i ,~l ii'ithin 

( *T f UUI Til J.'U'll CTST3C ORTCRI UJ T_*V UU11V fl 1 L I III I 

•34 hours of admission which includes 
reason foF admission, mental status fh- 



383 



6:8 NORTH CAROLINA REGISTER Julv 15, 1991 



PROPOSED RULES 



eluding suicide potential, admitting diag 

»i .Ail .-■ j-v-1 .1. It, ■. il hi, t/in - fi n ,~\ r>^«aj-ol rttil rif il 

condition, acti^itioo asoooomont, history ef 
9? assessment ef potontial fof physical 
abuse ef family members -of othors, a 
family asooosmont when minors are 
served, l e gal status e&4 substanco «se h+s- 

fB4 » inpatient hospital treatment, Fesi- 
dential troatmont ef rehabilitation, non 
hospital medical detoxification, a«4 
outpatient detoxification facilities, a mod 
ieal examination ohail be complotod 
within 34 hours e4 admission; a&4 

(G) except i» detoxification facilities, his- 
toricai material including social, logal, 
psychiatric, oducational a»4 vocational 
assonsmonts shall be completed within ZQ 
days ef admission. 

I T-i It • l 1 T I 1 : ■ i 1 I ImiiiMi- 'i t li , a t- , i [ l . » 1 1 .-. . ■ ' , . \\ t - t ItiII 



be made t» detormino appropriatonoos ef- 
continued service » the facility within 3© 

^^^^^^^ ^^i ■ i, If mil t i i nt - ^ r ^ 1 1 ^^L I t ^^^^^l^^^ ^J^j-^^^ 

UU| U ^TT UU 1 1 L1JJHJI T UIIU Lit IVTI.JI U T Ul T 1 1 1 1 t \J 

months thereafter. 
fe) Facilities Sorting Moro Than ©He Disabil 
ity (except fee sheltered workshops): 

(44 Aft admiooion note shall be completed fo* 
each client within 34 houro ef admission 
which includes at l e ast the following: 
(A4 the present condition e4 the client re- 
ported ift objective, behavioral terms; 
fB4 the reason for admission; and- 

y \~J I 1 I It? I [ill t It? l.'t 1 1 IKS tt TJTt Iff ICQ ITtTTTtTTTt I I BC 1 1 t T I 

professional, qualified developmental dis- 
abilities professional ef qualified sub 
stanco abuse professional as appropriate, 
who has designated responsibility fef the 
cli e nts treatmont, program ef ease man 
agement plan. 

44*e facility shall obtain assessment infor 
mation judged te be essential te serving 

< n . i .'li.i»< i «i t l-» . t I'li'iliti : f CO '"" * ti Q niifil.li.-i.l 

rrrc uituttt itt ii iu i ut i n i t , 1 1 \j 1 1 1 rxxc uuu 111 i vtt 

mental health professional, qualified de- 
volopmontal disabilities prof e ssional e* 
qualified substanco abuse professional 
who has designated r e sponsibility fef the 
client s treatment, program e* ease man 
agement plan. 
Afty other assossmont information re- 



& 



quired by the facility's own policies shall 
be completed e* obtained as required by 
those policies. 
(b) Each facility shall complete an initial ad- 
mission assessment for each client prior to the 
delivery- of treatment /habilitation services. The 
initial assessment shall include: 

(1) the presenting problem or reason for ad- 
mission; 



(2) the client's needs and strengths, and when 
appropriate, the needs and strengths of 
family members who may contribute to 
the services provided to the client; 

(3) a provisional or admitting diagnosis with 
an established diagnosis determined 
within 30 days of admission, except for 
clients admitted to a detoxification or 
other 24-hour medical program for any 
length of time, who shall have an estab- 
lished diagnosis upon admission; 

(4) a description of current status including 
the following, when applicable: 

(A) mental status, including suicide poten- 
tial; 

(B) developmental condition or impair- 
ment; 

(C) substance use or abuse; 

(D) legal status or circumstances; 

(E) medical condition; and 

(F) family and other support systems; 

(5) a description of the client's condition from 
family or significant others, when avail- 
able; and 

(6) the disposition, including referrals and 
recommendations. 

(c) Data gathered during a screening or from 
other sources within 30 days prior to admission 
may be used to complete the assessment. 

(d) For a client expected to receive services for 
more than 30 days, the admission assessment 
shall include the following within 30 days of ad- 
mission: 

( 1) a social and family history; 

(2) a medical history; and 

(3) when applicable, histories and assessments 
as follows: 

(A) psychiatric, including previous treat- 
ment; 

(B) substance abuse, including previous 
treatment; 

(C) developmental, including previous ser- 
vices received; 

(D) educational; 

(E) auditory and visual; 

(F) nutritional; and 

(G) vocational. 

Statutory Authority G.S. I22C-26; 130A-144; 
BOA- 152; 1 43 B- 147. 

.0315 TREATMENT/HABILITATION 

PLANNING AND DOCUMENTATION 

(a) The governing body shall have develop and 
implement written policies a»4 procedur e s fof 
the development ef regarding individual treat 
m e nt a»4 program treatment habilitation plans 
and the assignment qualifications based on edu- 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



384 



PROPOSED RULES 



cation and experience of staff responsibilities who 
will be responsible for implementation of such 
plans. 

fb4 Individual plans fof each client shall be 
based upon aft evaluation ef the cliont s oondi 
tion, assets aftd needs a»d the resources to moot 
thes e needs. This f4aft shall provide a systematic 
approach to the tr e atm e nt/ habituation ef the eh- 
e»t aftd substantiate the appropriatenosn ef the 
treatment ef habilitation goals. 44*e plan shall 
be developed » partnership with the client ef 
individual acting fo b e half ef the client. Clinioal 
responsibility fof the development and implo 
mentation ef the plan shall be designated. 
(e) Mental Health Facilities: 
(44 Inpatient psychiatric; residential acuto 
treatment; partial hospitalisation; rosidon 
ttaf treatment fof children asd youth; and 
day treatment fof children and youth fe- 
ciliti e s shall comply with the following 
requirements: 
(A4 A comprehensive treatment plan, based 
e» information gathered during the as- 
sessment process, shall be developed fo 
cooperation with the client a«d imple 
merited within 44 days ef admission, with 
the exc e ption ef inpatient psychiatric a»d 
residential acute treatment facilities 
wherein the plan shall be implemented 
within teft days ef admission. 44*e com 
pr e hensive plan shall includ e at l e ast the 
following: diagnosis and time specific 
short aed long term measurable goals, 
strategies fof reaching goals a»d staff fe- 
sponsibility fof plan implementation. 
(4^ Progress notes shall be completed e» 
at least a weeldy basis and refloct the eh- 
e nt's progress ef laelr ef progress toward 
meeting goals, staff interventions aed fo- 
formation which fftay have a significant 
impact eft the cli e nt's condition. 
(€4 A thorough review ef the comprohen 
sAe treatment plan shall be earned e«t 
tm4 documented to the plan at least every 
sA months ef more frequently if medically 
ef clinically indicated. 
(3) Group homes fof adult a»4 elderly indi 
viduals wbe afe mentally ill shell comply 
with the following requirements: 
(A+ Individual client plans shall be devel 
oped fo cooperation with the client , the 
facility staff aftd the mental health profes 
•l ional who is responsible fof the trcatmont 
ef t?ase management ef the client within 
44 days ef the cli e nt's admission to the 

f i.'ilih: I hit t-* 1 .1 «-> , |-i . i 1 1 ih,'Iii,1,\ ■ t t 1 . i ' i ■ - + th,i 

rTTTTrnTTT 1 1 1L I ' 1UJ 1 rTTCTTT till IUUL 1 FIT RTO -I I 1 1 1U 

following: time specific short an4 long 
term goals to be addressed bv the client 



a»4 the facility staff; documontation ef 
coordination ef the plan fof the client 
with the comprehensive troatmont plan 
aftd the designated troatmont responsibil 
ities ef the mental hoalth professional 
providing treatment a»d the responsibil 
foes ef the facility staff. 

(444 Progress notos shall be complotod eft a 
monthly basis which reflect the client's 
progress ef laek- ef progress toward meet 
fog goals; documentation ef coordination 
between the facility staff aft4 the mental 
hoalth professional whe- is responsible fof 
treatment; a»d a»y- other information 
which Fftay- have a significant impact e» 
the client's condition. 

(+S4 A thorough review ef the plan shall be 
carried e«t a»d documented fo the plan 
at l e ast annually ef mora frequently if 
medically ef clinically indicated. 
(44 Psychosocial rehabilitation programs shall 
comply with the following requirements: 

(A} A plan shall be developed fo cooper 
ation with the client within ^0 days ef the 

/^1ii-i>i< .- 'i ■ 1 m i.'.-ijiti t/i tli.i t I i . » i I i t l I _Lji^ 1 ~l I 111 

men o uu iii loom i i kj h i\j iul lxi it • i i i\j i ? i in i 

shall include at least the following: 

(+4 assessment ef client's strengths asd 

weaknesses; 
(ft) individual service goals aftd activiti e s 

fo which the client w-ffl participate; a»d 
(444 designation ef staff responsibility fof 

coordination with goals contained fo 

the client's comprehensive treatment 

plan. 
(444 Progress notes shall be completed e» a 
monthly basis which document the eh- 
ent's progress toward goal achievement 
aft4 other significant information regard 
fog the client's situation. 

/ I t I tl ■ t »-» 1 ■ ■ I 1 i ■ Vl ■ . 1 1 1^^ f- . H • ■ , ^ \ 1 - . A , 1 'Ul,l I' ll ' lllI'lV 

^ >— 7 1 RQ I ' RD I Ol I II 1 1 1 1 \J IL I l^'IILU U.1 ITJ L 1 1 U 1 1 Eva 

documented at least e v e ry sA months ef 
more frequently if indicated based e» eh- 
eftt functioning. 

(4) Afty facility which s e rves individuals e» a 
drop in basis shall maintain a daily at- 
tondanc e legr a daily activity plan, a»4 
documentation ef referrals to oth e r ser > ice 
providers. 
(d4 Developmental Disabilities Facilities aftd 
Sheltered Workshops: 

(44 Individual program plans shall be dev e l 
oped aftd implemented within 44 days ef 
admission to all faciliti e s with 4+e oxeop 
tfoft ef respite ea*e programs. 44*e plan 
shall be reviewe d at least quarterly aftd 
assessed a«4 redeveloped at least annually. 
£ef clients fo ADAP facility based models 
a«4 sheltered workshop placements, 4*e 



385 



6:S NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



annual assessment shall includ e a review 

to determin e toe need fof referral to V-e- 

cational Rehabilitation ef other services. 

ffof clients to A DAP Supported 

Employment Long Term Support, it shall (3) 

includo a» indication ef toe Wei ef need 

fof long term support activities a»4 toe 

specific type ef support required. Pro 

gram plans shall provido toe basis fof toe 

development ef individual geel plans. 

Program plans shall provido a systematic 

approach to toe habilitation ef toe client 

a»4 substantiate toe appropriateness ef 

toe habilitation goals. Program plans 

shall be dovclop e d to partnership with eto- 

etos ef individuals acting to behalf ef ek- 

onts. Clinical responsibility fof toe 

developm e nt afto implementation ef pro 

gram plans shall be designated, to addi 

tion, to faciliti e s serving infants, toddlers 

&f preschool age children, except fog those 

providing respito sendees, toe program 

plan is referred to a* toe Individual Lied 

Family Service Plan (IFSP) a&4 shall to- 

clude: 

(A) a description ef toe child's present \&r- 
els ef physical development, includmg vi- 
sion, hearing a»e health status, cognitive 
development, languago atto speech devol 
opment, psychosocial development afto 
self help sldlls; 

fR} with toe concurrence ef toe family, a 
description ef toe family's strengths a»d 
needs related to enhancing toe d e velop \^> 

ment ef toe child; 

(G) goals tot toe child's family as weU as 
goals fof toe child; 

(-D) criteria affo timeframe to be used to 
d e t e rmine progress towards goals; 

f&) planned habilitation procedures related 
to toe goals; 

fp} a statement ©f toe specific early inter 
vent ion servic e s to be provided to meet 
toe id e ntified child as4 family needs, a»4 
toe initiation dat e s, frequency a»d 
m e thod, duration, intensity a»d location 
ef service delivery a«4 toe persons ef 
ag e nci e s responsible; 

{Q} toe d e signation el toe staff member m- 
sponsible tot ease management services; 

(44-) toe plans fof transition iftto serrices 
which ate toe responsibility to toe N.C. 
D e partment ef Public Instruction; 

(44 toe payment arrangements fof toe spe- 

etoie sendees delineated to Subparagraph (4) 

(d)(1)(F); a»4 

f4-) a d e scription ef medical afto other sef- 

* rccs 1 1 in. i ti iv emm 1 i\_ i'u >.' l* hi ? t ilh.ii tn v.* 



Hto required undor PL. 99 ' 157 aftd toe 
strategies to be pursued to s e cur e those 
sendees through public ef private Fe- 
souroos. 

i i iv unii cd uv r v. n_^r'i i ivi it hi m ctttttttctt r^^^rc^^n 

process fof toe IFSP fof infants, toddlers 
a»4 preschoolers shall includo partic 
ipation by* 

(A) toe parent ef parents ef toe child; 

ff£) other family members, as r e quested by 
toe parent; 

(G) a» advocate ef person outsid e ef- toe 
family if toe parent requests toat toe pef- 
seft participate; 

f&) toe provider ef toe early intonontion 
son'icos; 

(&) toe Gase manager designated fof toe 
family if different; aa4 

£F) toe provider ef toe ass e ssment sendee 
if different. 

¥be quarterly review process shall include 
participation by persons identified to 
Subparagraphs (d)(2)(A) through (E)r If 
a»y ef these individuals afe unable to at- 
tond e«e ef toe referenced development 
ef review meetings, arrangements shall be 
made fof toe person's involvement 
through other moans such as participation 
to a telephone conference eafo having a 
knowledgeable authorized representativ e 
attend toe meeting ef making pertinent 
records availabl e at- toe meeting. 

44*e IFSP fof infants, toddlers as4 
preschoolers is based upon toe results ef 
toe assessment referenced to 4-0 NCAC 
444v .031 1(c). Howev e r, e arly int e r 
vontion sendees m&y commence before 
completion ef ttos assessment if parental 
cons e nt is obtained, toe assessment is 
completed within toe timo poriod refer 
eftee4 to 40 NCAC 4-444 .f)312( - 1)(c), af>4 
a» interim IFSP is developed. 44*e to- 
terim IFSP shall includ e : 

/ A \ I H.i » nn.i I 1 T * l-i Q ftQ gfl rt-\ • i r-» ■ . . ■■ tf 11 hj-\ 1 1 -i I I 

\ I 1 J TTrC rTTTTTTC PT 1 1 l\J \JKX-J\-' I I llll 111 EC I Tl UU TT lit 

be responsible fof toe implementation ef 
toe IFSP a&4 coordination with other 
agencies aft4 individuals; 

ff£) Short ter fa- quarterly goals fof toe child 
a»4 family when recommended; 

(-£4 Fhoso e arly intonontion sendees toa* 
afe needed immediately; afto 

f{4} Suggested activities foet- may be carried 
eto by toe family members. 
Each facility ef individual wke- has a direct 
fele to toe provision ef early intonontion 
sendees specified ift foe IFSP is rosponsi 
b4e fof making a good faith effort to assist 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



3S6 



PROPOSED RULES 



each eligible child to achieving tbe goalo 
set tortb to the IFSP. 

(5) 4toe IFSP sbab be developed within 44 
days e£ referral fof those children deter 
mined to be eligible?. 

(-6+ Individual goal piano oh all be develop e d 
to tbe appropriate developmental a«4 ve- 
cational sbib ar e as. Goal piano ohall be 
ass e ssed ee a quarterly baoio to ab facilitieo 
w*tb tbe exception to" developmental dioa 
bility aftd behavior disorder group homos 
wherein e&ai plans shall be assessed eft a 
monthly basis. Such assessment shall ad- 
dress tbe client's progress e* laeb ef 
progress toward meeting tbe plan aftd Fe- 
vi e w ef tbe plan fof appropriateness ef 
established goalo. Individual geai plans 
a?e ftet- required fe* clients i» supervised 
independent living, alternative family Ito- 
togr sheltered workshops aftd ADAP eb- 
efto to supported employment. 
Individual eeal piano ate ake- net- required 
fof ADAP clients targeted to? supported 
employment e* those to the intensive 
training period e* tbe long term support 
period e£ supported employment. 4to be 
targeted a* a supported e mploym e nt eb- 
efrtr tbe client muot have been determined 
» writing to be appropriat e fof supported 
employment by- representatives ef tbe fe- 
cility. toe local Hftft to" toe Division ef 
Vocational Piohahilitation Services aftd- 
toe jVrea D e velopmental Disabilities Spo 
cialiot eff toe Afea Mental Health, Mental 
Retardation aftd Substance Abuse Pro 
gram e* hb> designee. 

^*i to. sp e cialized community residential ee«- 
tefSj nursing eaie plans ohall be developed 
a»d implement e d to addition to toe mdi 
vidual program plan, 4toe nursing safe 
f4a» muot address medical needs aftd 
nursing car e . Such plans ohall be int e 
grated with individual geai plans. 

f&+ to developmental disability a»4 b e havior 
disord e r group homos, toe individual Bfe- 
gram plan shall specify a tim e sp e cific ad- 
mission to less than sis months, to be 
extended a*, needed ©ft a six month basis. 
a»d shall emphasize programming objec 
tiveo toat assist toe client » e.xitmg to a 
le~T restrictive setting. 

f9f Progress not e s shall be compl e t e d which 
reflect toe cli e nt s progress &f laeb &f 
progress toward meeting program pia» 
goals, staff interventions aftd a»y- infor 
mation which f»ay- hav e a significant hb- 
paet e» the client's condition. 



Documentation ohall be made iff a»y- 
conferences 9f involvomonto w4to toe eb- 
ont's family &f involved agencies. 

(A) Progrooo notes fof r e spite sendees shall 
be completed after e ach respite episode. 

f&) Progress notes tof developmental disa 
bility aftd- behavior disorder group homeo 
shall be completed at least monthly. 

(-&+ Progress notes to ab other services shall 
be &» at- least a quarterly basis. 

(©) Fxcept fop respite services, when toe 
client is a minor, progress r e ports r e gard 
i»g the program plan shall be given to tbe 
legally responsible person ©» a quarterly 
basis. 
fe} Substance Abus e Facilities": 
bb) 4toe preliminary treatment plan &f 
detoxification instructions shall be initi 
ated within 34 hours e£ admission aftd 
shall be based upon informat toft gathered 
during toe admission assessment. 
Qrf 4toe comprehensive treatment plan fof 
clients to therapeutic homes aftd outpa 
tient tr e atment facilitieo shall be implo 
mented within 4b days ef admission. 4toe 
comprehensive treatment plan tof cli e nts 
to inpatient hospital treatment programo 
aftd resid e ntial treatment habilitation fo- 
cilities shall be implemented within lea 
days ef admission. Such plan shall «- 
clude diagnosis, time specific short aftd 
long term measurable goals, aftd- strategies 
fef reaching goalo. 4toe treatment plan 
shall be r e vi e w e d aftd revised whenever 
medically &f clinically indicated ef at- l e ast 
ever , si* months. 
(3) Progress notes shall be written to reflect 
toe clients progress &f bteb e£ progress 
toward meeting toe treatment plan goals 
aftd shall reflect staff int e rventions aftd 
afty- information which f»ay- have a signif 
ioant impact e«- tbe client s status. Doc 
umentation ohall be mad e &f a»y- 
conferenc e &f involvements with tbe eb- 
ent s family ef involved agencies aftd a»y- 
major events related to tbe client. 

(A) Progress notes to outpati e nt sonicoo, 
including outpati e nt detoxification sef- 
vices, shall be completed afeep eaeb client 
visit. 

f&^ Progr e ss not e s shall be completed 
weekly » resid e ntial treatment habili 
tation facilitieo aftd therapeutic homes. 

^Q} Progress notes ohall be completed »ft 
eaeb client » social setting aftd nonhoo 
pital medical detoxification facilities at 
least ever . ' eioht hours. 



3S7 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



{©} fo inpatient hospital treatment facili 
tiesr progr e ss notoo shall be complotod e» 
e ach shift. 
f&) A weekly summary noto shall be com 
ploted » halfway houses, supervised ind e 
pondont Uving a«4 alt e rnative family 
living. 
(i) Faciliti e s S e rving Mor e Than Qjh» Disability 
(oxcopt fot sh e lt e red workshops): 

(4} A» individual eliont plan fef services te- 
be provided by tbe facility shall be devel 

i~\r\i~iiA ii-AinHn l-ki r * Vt Q />li,int l-wiliti 1 rt-iff • ■ pj 

tTTT^TT IT.TTI III T ITT TTTU 11 ill] lUUllllT !_TtllI I CTTTTT 

tbe qualified mental health professional, 
qualiliod developmental disabilities pte- 
f e ssional e* tbe qualified substanco abuse 
professional, as appropriate, who is Fe- 
sponsibl e fop tbe client's treatment, pro 
gram ef ease management plan within 4© 
days ef admission te- the facility. This 
plan shall includ e at- roast the following: 
(A} Specified goals sad- strategies te- be ear- 

1~1. "ii 1 i 1| I t Ky f l^ t * 1 ■ I J ' 1 1 I 1 1 1' ■ t ■> t t t .-» g i i iinn r-t t ti ,1 
I fW UUl vj 11 Iv lUVliil T JllU 1 ll_J UU L' LHJ 1 I TTT^ 

attainment »f goals specified by the quali 
Se4 mental health professional, qualifiod 
developmental disabilities professional ef 
qualified substanc e abuso professional 
who bas designated responsibility for tbe 
client's treatment, program et ease man 
agoment plan. 
fB) Documentation ef joint d e velopment 
ef tbe individual client plan by the client 
e* legally responsible person, the facility 
staff and- the professional who bas desig- 
nated r e sponsibility fot tbe client's treat 
ment, program ef ease management plan. 
(-2} Progress notoo shall be complotod e» at 
least a monthly basis which reflect: 

I J j I I") . \ j di.itit l- i-irn .Tr-iif f j-i r I rwl.' j~t 1 «-. r^ . m \ ,- ■■ 

yT rT 1 1 IO vXXCTZT J ITITTtrvOT UI 1UL11 OT ITT VT E^T^TOW 

» relation to- bis goals and stratogios 
within tbe client plan; and 
f&) Documentation ef coordination be- 
tween tbe facility and tbe professional 
who bas designated r e sponsibility fof tbe 
client's tr e atment, program e* ease man 
agement plan. 
(4) A thorough review ef tbe individual client 

P I ' I I t I *"* ' ' I I "' * ' * I I BB Q d f "* * ' * anniifilli I r-\ t- rrvrvrvi 
J. ' tun TTTCTTT DQ t-TTI TILU ITUl HI tl I UUII Y 1.7 1 rTTTTT^? 

frequently if medically e* clinically indi 
catod. T-be review &f tbe individual client 
pfe» shall be conducted cooperatively by 

t n 1 1 I' HMlt t \t It'W*'! I II I rrtm.-irn'ikl.i rtagfi , t .i t \t . -\ 

facility steff a«4 tbe professional wbe bas 
designated responsibility fop tbe client's 
treatment, program e* ease management 
plan. 
(b) A treatment /habitation plan shall be based 
upon an assessment of the client's condition, as- 



sets and needs, and the resources to meet these 
needs. 

(c) The parent or the legally responsible person 
of a minor shall have the opportunity to partic- 
ipate in the development and implementation of 
the minor client's individual treatment/ habi- 
tation plan. 

(d) The parent, with client consent, or the le- 
gally responsible person of an adult shall have the 
opportunity to participate in the development 
and implementation of the adult client's individ- 
ual treatment /habilitation plan. 

(e) Clinical responsibility for the development 
and implementation of the treatment habilitation 
plan shall be designated. 

(f) Initial treatment /habilitation objectives shall 
be documented, if services are to be provided, 
prior to the establishment and implementation 
of the comprehensive treatment/habilitation 
plan. 

(g) Except as provided in Paragraphs (j} 
through (j) of this Rule, a comprehensive plan 
shall be developed and initiated within 30 days 
of admission for clients who are expected to re- 
ceive services from the facility beyond 30 days. 
The plan shall include, as appropriate to the cli- 
ent's needs: 

documentation of the established diagno- 



ill 

01 

(41 

121 



sis: 



time-specific, measurable 
treatment habilitation ; 



goals for 



general strategies or procedures to be 
undertaken in order to meet goals and the 
direct care stall responsible for implemen- 
tation; 

time-specific, measurable education or 
treatment goals for family or significant 
others, if applicable; and 
a schedule for time-specific planned re- 
views, which may be set, in addition to 
those required in Paragraph (h) of this 
Rule. 

A full review of each client's 
treatment/habilitation plan shall be conducted at 



till 



least annually by the responsible professional in 
accordance with the facility's quality assurance 
plan, as determined by_ 10 NCAC 14K .0319. 
The review shall include: 

( 1) the client's continuing need for service; 
and 

(2) a continuation or update of the client's 
treatment habilitation plan as defined in 
Paragraph (g) of this Rule. 

(i) The goals for a client who receives services 
from facilities providing day activity or alterna- 
tive family living, half- way house, therapeutic 
camp or group home services in which the 
supervision and therapeutic intervention are lim- 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



MS 



PROPOSED RULES 



ited to sleeping time, home living skills and lei- 
sure time activities, may be limited to life -skill, 
mh i.il or recreational goals, 
(j) The goals for a client who receives sen-ices 
from a community respite facility may be limited 
to the special needs of the client, including 
medications to be administered, dietary consid- 
erations and expectations regarding other ser- 
vices. 

Statutory Authority G.S. 122C-26; 143B-147. 
.0316 DISCHARGE/AFTERCARE (REPEALED) 

Statutory Authority G.S. I22C-26; I43B-147. 

.0317 CLIENT RECORDS 

(a) Facilities shall maintain a client record for 
each individual admitted to the facility. 

(b) Each client record shall contain an identifi- 
cation face sheet which includes at least the fol- 
lowing identifying information: 

(1) client name (last, first, middle, maiden); 

(2) client record number; 

(3) client address; 

(4) also known as; 

(5) date of birth; 

(6) race, sex and marital status; 

(7) social security number; 

(8) home telephone number; 

(9) work telephone number; 

(10) name, address and telephone number of 
legally responsible person or next of km; 

(11) admission date; and 

(12) discharge date. 

fef Client specific requirement -, delineated i» 
Rules .0312 through .0316 el this Subchapter 
shall be documented i» At* cli e nt r e cord. 

f4} Information r e quired m- other ruloo i» this 
Subchapter (such asr btri- need ftet be limited te? 
medication prescribing, administering 

medication, medication education, restraint e* 
seclusion afttl laboratory services) shall be docu 
mented m- the client record. 

fef Additional information which shall be ift- 
cluded m the client record jftay include the fol- 
lowing: 

f4-) diagnostic tests, assessments, e valuations, 
consultations, referrals, support services 
ef medical services provided; 
(-2-} known allergies e* hypersensitivities; 
(4) major events, accidents ef m e dical emer 

gencies involving the cli e nt; 
f-ty consent fofy aftd- documentation ef-r Fe- 

lease ef info nnat ion; 
(4) documentation el applied behavior mod 
llication which includes at- risk ef other 
intrusive? interventions, including authori 



zation, duration, summaries &f obsorva 

ties- a«4 justification; 
(6) conferences ef involvements with the ek- 

e nt s family, significant oth e rs ef involved 

agencies e* service prosiders; 
P) documentation »f attempts te- asc e rtain 

why- a client is »et attending a sorvico m 

accordance? with his established schedule; 

(£)• docum e ntatiem el attendance i» sorvicoo 
other than r e sidential services. 
(£) All client record entries shall include the 

dit.l ■■■V 4 ; H T j r-\ | 'ill, 1 -II l) ll.itltl.'.tl.Hl t~« 1 | <Un HI/llVl.llI'll 

UUIU C7T II III T (TTTO HTJt I T TC. I Tl [CD LM MI rT UIV 1 1 X\J 1 T IUUUI 

making the entry. Time shall be recorded based 
upon the nature el services (e.g., shift not e s, 
medication administration, accid e nts ef injuries, 
at risk- procedures). 

(g) AH client record entries shall be legible aftd 
made m permanent iftk- &p typewritten. 

(h^- Alterations » client records, which a*e 
necessary » order te- correct recording errors ef 
inaccuracies, shall be made as follows: 

(44 Alterations shall be mad e by- the individ 

wal who recorded the entry. 
(-2) A single, th» lifte shall be drawn through 
the error ftp inaccurate entry with the eri- 
ginal entry still- legibl e . 
(34 The corrected entry shall be legibly re- 
corded above et eeaF the original e ntry. 
A» explanation as te- the type el doc 
umentation e rror ef inaccuracy shall be 
record e d whenever the reason fof the error 
» unclear. 
(4-) Alterations includ e the date ef correction 
a«4 initials ef recorder. 

the facility shall include the client's name aftd- 
client record number, when assigned. 

(j4 Client records shall contain only symbols 
a»4 abbreviations included eft a« abbreviation 
list approv e d by the facility. 

(4*4 Notations i» a client's record shall ftet pef- 
sonally id e ntify oth e r clients. 

(1) Each facility shall designate i» writing those 
individuals authorised te document i» client Fe- 
cords. 

(fft} Forms aftd- court orders relative te the ad- 
mission e? commitment el clients shall be ince^r 
porated iftte the client record. 

[cj_ Each governing body shall develop and 
i mplement written policies rcjardim:: 

( 1) the persons authorized to document in 
service records; 

(2) the correct procedures to alter or correct 
recording errors or inaccuracies; 

(3) the documentation and maintenance of 
information on incident reports; 

(4) the transportation of records; 



.?<V9 



6:S NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



(5) the safeguard of records against loss, 
tampering, defacement, or use bv unau- 
thorized persons; and 

(6) the assurance of records accessibility to 
authorized users at all times. 

(d) Each facility shall ensure that: 

( 1) the facts relative to the observed or sus- 
pected abuse of a client shall be docu- 
mented in the service record including 
reports made bv the individual client and 
actions taken by staff. Opinions related 
to the abuse or alleged abuse shall not be 
documented in the service record; and 

(2) information relative to AIDS or related 
conditions is disclosed only in accordance 
with the communicable disease laws as 
specified in G.S. 130A-143. Anonymous 
testing of individuals for AIDS shall be 
filed separately from client records and 
shall not be filed in anyway which identi- 
fies a specific client. If not conducted 
under anonymous procedures, when a 
client is tested by a facility for the HIV 
antibody, the written consent of the client 
and the test results may be incorporated 
into the client's record. Any other kind 
of substantiated information relative to 
AIDS may be placed in the appropriate 
client's record. 

(e) All medication regimes prescribed bv a fa- 
cility physician shall be reviewed for appropri- 
ateness by a physician at least every six months; 
except methadone, which shall be reviewed with 
the client everv three months. 



.0334 SUBJECT PARTICIPATION IN 
RESEARCH PROJECTS 

(a) Informed, written consent shall be obtained 
from each subject client in a research project, or 
from the legally responsible person, if a subject 
the client is incapablo ef providing informed 
written consent as folio wo: a minor or incom- 
petent adult, to include the following: 

(-4-} subjects shall be informed ef any potential 
dangers ef risks that may esist as a result ef 
participation; 

(■3) subjects shall be informed as to what their 
participation wiU entail as related to tea© 
aa4 effort, futuro follow up, contacts with 
other people about thorn, afi4 alterations el 
regular procedures; 

(1) (4) documentation shall be made tbet the 

participants have that the client has been 
informed of any potential dangers that 
may exist and that they understand he 
understands the conditions of partic- 
ipation; and 

(2) f-ty each individual participating » a Fe- 

searoh project shall have the notice of the 
client's right to terminate participation at 
any time without prejudicing the treat- 
ment he is receiving. »f his e mployment 
» the agency; a»4 

(b) fS} A copy of the dated, signed consent form 
shall be kept on file in the client record by the 
facility, staff. 

Statutory Authority G.S. 122C-26; 122C-52; 
143B-J47. 



Statutory Authority G.S. 122C-26; I43B-I47. 

.0320 INCIDENT REPORTING 

Each facility governing body shall have develop 
and implement a written policy for reporting all 
incidents, unusual occurrences or medication er- 
rors regarding clients. The policy shall provide 
fof the following: 
(44 prompt r e porting ©f the incident to appro 
priate persons within the facility aft4 prompt 
emergency eafe when indicated; 
(3) documentation &f the essential facts sw^ 
rounding the incident with such documon 
tation maintained m administrative files; 
(34 periodic review ef incident reports by staff 
members to d e termine the cause &f such m- 
cidents a«4 to r e commend preventive moas 
wes aft4 corrective actions; aa4 
(44 evidonco &f corrective action taken, as ap- 
propriato, to implement recommendations. 

Statutory Authority G.S. 122C-26; 143B-147. 



.0337 EMERGENCY CARE PERMISSION 

Upon the client's admission, Each facility shall 
secure a signed statement from the client or le- 
gally responsible person granting permission to 
seek emergency care from a hospital or physician. 

Statutory Authority G.S. 122C-26; 143B-147. 

.0348 DOCUMENTATION OF LABORATORY 
TESTS 

(a) Each facility shall document in the client 
record the following information regarding each 
laboratory test administered: 

(1) name and date of any laboratory test or- 
dered; 

(2) name of physician ordering test; and 

(3) date and time specimen obtained. 

(b) The original copy of the report of labora- 
tory test results shall be included in the client re- 
cord. 

(c) This Rule shall not apply to testing done 
anonymously for HIV infection. 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



390 



PROPOSED RULES 



Statutory Authority G.S. I22C-26; I43B-I47. 

.0349 PRESCRIBING OF MEDICATION 
(REPEALED) 

Statutory Authority G.S. 122C-26; I43B-I47. 

.0351 ADMINISTRATION OF MEDICATION 

(a) Prescription modioation shall be adminio 
torod only ©a toe writt e n ©f verbal order ©f a» 
authorized proscribor. 

fb} Over tho counter (non prescription) 

medication shall be administered to inpatient fa- 
cilities a»4 to minors a©4 incompetent adults to 
residential facilities only e» the written approval 
©f a physician ©f person authorized to prescribe 
leg e nd drugs. 

fe) Over the count e r (non proscription) 

medication shall be administered to minors ©f 
incompetent adults to aff other faciliti e s only ©» 
the written approval ©f the legally responsibl e 
person. Over the counter (non proscription) 
medication shall be administered to a minor 
ooolring treatment without parental consent only 
©a the written approval ©f a physician. 

(4) Only properly labeled em4 dispensed 
medication shall be administered. 

(e) Medication shall be administer e d to inpa 
tient facilities only by a physician, physician as- 
sistant ©f nurse. to other facilities, medication 
may be administered by? ©f self administration 
supervised by? program staff who have received 
instruction about each medication, dosag e , time 
©f administration, side effects afto 
contraindications from either the facility's physi 
oian , ©f b» design oo, ©f toe l e gally responsible 
porr . on. A fct ©f persons approved to administ e r 
medication shall be maintained by- the facility. 

(£) A physician shall approve to writing toe 
self administration ©f prescription a«4 over tho 
count e r (non pr e scription) medication by clients 
to inpatient facilities ©f minors ©f incompetent 
adults to residential facilities. A minor eg toe le- 
gally responsible p e rson ©f a minor ©f incompo 
teto client shall obtain physician cons e nt to 
writing £©f toe self administration ©f prescription 
©f over tho counter (non prescription) 

medication to outpatient, day-night facilities. 
Tbe competent adult client m&f s e lf administ e r 
prescription ©f over the counter (non 
prescription) medication to outpatient, day ■ night 
©f residential facilities. Whore applicable, clients 
should r e c e iv e training i» toe self administration 
©£ medication. 

fg-) ^toe administration ©f medication by staff 
shall be documented to toe client record ©» a 
facility maintained individualized m e dication a4- 
ministration r e cord. The medication adminis 



tration record shall contain documentation ©f 
doses administered. 
(b} Modioation administration errors afto ad- 

UO££A ' ''■! i i i j-n-1 ^tinnr r V» n 1 1 W^ fAfn f/1 .-» ri t n tlri .-.I m t-m ♦ 

? *-"! JV T_II UC, 1 lAIUl IT. 'I ITT 91 ITJ.1I l^U rTT^TWCW LIT TTT^ CTT^^TT 

rocord as*4 reported to toe proscribing physician 
immediately. 

Whenever a facility administers medication, 
documentation in the client record shall include 
the following: 

(1) Written medication orders signed by the 
prescnber. 

(2) Assessment by physician of chent's drug 
therapy regimen for appropriateness, at least 
every six months. 

(3) Individualized record of medication admin- 
istered by qualified program staff including 
record of doses administered. 

(4) Written approval of the legally responsible 
person of a minor or an incompetent adult 
is required before administering over-the- 
counter non-prescription medications. 

(5) For minors seeking treatment without par- 
ental consent, a physician or other person 
authorized to prescribe legend drugs must 
approve the use of over-the-counter (non- 
prescription) medications during the time 
when the minor is in the care of an area 
program service component. 

(6) Documentation of medication adminis- 
tration errors and adverse drug reactions, 
and immediate notification of prescribing 
physician. 

Statutory Authority G.S. 90-21.5; 90-171.20 (7), 
(8); 90-177.44; 122C-26; I43B-147. 

.0354 MEDICATION EDUCATION 

(a) Each client to be started or maintained on 
prescription medication shall receive individual 
or group education regarding prescribed 
medication. 

(b) The physician or his designee shall assess 
each client's ability to self- administer medication 
as well as other factors that may affect drug 
therapy. In instances where the ability of the 
client to understand the medication education is 
questionable, a responsible person shall be pro- 
vided with the opportunity to receive both writ- 
ten and oral instructions on behalf of the client. 

(c) The prescribing physician or other person 
approved by the physician shall provide the fol- 
lowing written a«4 ©fal information to the client 
or responsible person at a time deemed appro- 
priate by the physician: 

(1) the name, appearance an4 dosage regimen, 
intended use and common side effects of 
the medication; 



391 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



(2) adverse reactions or uncomfortable side 
effects that should prompt calling a phy- 
sician; 

food, drugs or beverages that should be 
avoided or taken with medication; 
an alternative dosage regimen if a dose is 
missed; 

the expected length of the medication 
treatment; 
refill instructions; 

the proper place to store medication; and 
the need to communicate and coordinate 
with other physicians of the client regard- 
ing prescription medications. 
The medication education assessment and 
information provided shall be individualized fof 
oach client and documented in the client record. 
(e) Medication education ohall be coordinated 
with the discharging ef receiving program. 



(3) 

(4) 
(5) 

(6) 

(7) 
(8) 



(d) 



Statutory Authority G.S. 
143B-147. 



122C-26; 130A-361; 



SUBCHAPTER 14L - LICENSURE RULES FOR 
MENTAL HEALTH FACILITIES 

SECTION .0300 - PARTIAL HOSPITALIZATION 

FOR INDIVIDUALS WHO ARE ACUTELY 

MENTALLY ILL 

.0309 ROLE OF THE PARENT OR THE 
LEGALLY RESPONSIBLE PERSON 
(REPEALED) 

Statutory Authority G.S. 122C-26: 143B-147. 

SECTION .0400 - PSYCHOSOCIAL 

REHABILITATION FACILITIES FOR 

INDIVIDUALS WHO ARE CHROMCAULY 

MENTALLY ILL 

.0407 EMPLOYMENT SERVICES 

(a) Each facility shall provide or secure through 
the Division of Vocational Rehabilitation Ser- 
vices transitional or supported employment ser- 
vices to facilitate client entry into competitive 
employment. Full use shall be made of existing 
community resources to accomplish this includ- 
ing applying for funds available from Division of 
Vocational Rehabilitation Services. 

(b) When supported employment services are 
provided by the facility, the following require- 
ments shall be met: 

(1) Each client shall be one for whom com- 
petitive employment has not traditionally 
occurred or has been interrupted or inter- 
mittent as a result of severe mental illness. 

(2) Each client shall be employed in an inte- 
grated work setting for twenty or more 
hours per week. 



(3) Supported employment may be provided 
through: 

(A) work stations for a group of eight or 
fewer workers trained and supervised in 
an industry or business; 

(B) job coaching and supervision of indi- 
viduals in an industry or business; 

(C) mobile crew service jobs by a group of 
eight or fewer workers in the community 
under the training and supervision of a 
crew leader; and 

(D) small business enterprises operated with 
eight or fewer workers with training and 
supervision provided on site. 

(c) When transitional employment services are 
provided by the facility, the following require- 
ments shall be met: 

(1) There shall be a contract between the fa- 
cility and employer for a specific job and 
the job shall first be performed by a facil- 
ity staff member to determine the techni- 
cal requirements of the job. 

(2) The selection of a client to fill a placement 
is the responsibility of the facility and the 
individual client. 

(4) Each client participating » transitional 
employment shall be e valuated at the br4 
ef si* months te- d e t e rmine the appropri 
atenooo ef continuing te r e ceive transi 
tional employment services. 

(d) Wages shall be paid in accordance with the 
Fair Labor Standards Act for all clients receiving 
supported employment and transitional employ- 
ment services. 

Statutory Authority G.S. 122C-26; 143B-147. 

SECTION .0500 - GROUP HOMES FOR ADULT 

AND ELDERLY INDIVIDUAUS WHO ARE 

MENTALLY ILL 

.0506 PROGRAM ACTIVITIES 

(a) Each client shall participate in the overall 
operation of the residence including participation 
in routine activities such as maintenance and 
meal preparation. 

(b) Each facility shall establish a resident 
council that meets on a regularly scheduled basis 
to discuss the client's responsibilities and issues 
related to facility activities. 

(c) Each client shall be involved in treatment, 
rehabilitation, vocational, educational, or em- 
ployment activities outside the facility on a regu- 
lar basis as specified m the client's individual 
treatment plan, in accordance with the needs of 
the client. 

Statutory Authority G.S. 122C-26; 143B-147. 



6:8 NORTH CAROLINA REGISTER July 15, 1 99 1 



392 



PROPOSED RULES 



.0507 LEVELS OF CLIENT SUPERVISION 
(REPEALED) 

Statutory Authority G.S. 122C-26; 143B-I47. 

SECTION .0600 - RESIDENTIAL TREATMENT 

FOR CHILDREN AND ADOLESCENTS WHO 

ARE MENTALLY ILL 

.0607 TREATMENT PROGRAM {REPEALED) 
.0608 EDUCATIONAL PROGRAMS 
(REPEALED) 

Statutory- Authority G.S. 122C-26; 143B-147. 

.0610 ROLE OF THE PARENT OR THE 
LEGALLY RESPONSIBLE PERSON 
(REPEALED) 

Statutory Authority G.S. I22C-26; 143B-I47. 

SECTION .0700 - DAY TREATMENT FOR 

CHILDREN AND ADOLESCENTS WHO ARE 

EMOTIONALLY DISTURBED 

.0710 ROLE OF THE PARENT OR THE 
LEGALLY RESPONSIBLE PERSON 
(REPEALED) 

Statutory Authority G.S. 122C-26; 1 43 B- 1 47. 

SUBCHAPTER 14M - LICENSURE RULES FOR 

MENTAL RETARDATION/DEVELOPMENTAL 

DISABILITIES FACILITIES 

SECTION .0100 - SPECIALIZED COMMUNITY 

RESIDENTIAL CENTERS FOR INDIVIDUALS 

WITH MENTAL RETARDATION OR OTHER 

DEVELOPMENTAL DISABILITIES 

.01 10 DAILY TRAINING ACTIVITIES 

(a) Daily training activities shall be scheduled 
to meet the developmental needs of each client. 

(b) Activities shall take into consideration the 
length of time each client should be scheduled for 
needed rest periods, his need for individual at- 
tention, and special limitation of activities and 
diets. 

(c) Both free play and organized recreational 
activities shall be provided as appropriate to in- 
dividual needs. 

(d) Field trips and community experiences shall 
be provided for individual clients. 

(e) Daily routines common to non- 
handicapped clients shall be followed. 

(f) Daily outdoor activities shall be planned in 
acceptable weather when appropriate to the 
health and physical needs of the client. 



(g) When adults are served, vocational services 
shall be provided unless there is documentation 
ef medical contraindication. 

Statutory Authority G.S. 122C-26; 143B-147. 

.0113 PARTICIPATION OF THE FAMILY 

OR LEGALLY RESPONSIBLE PERSON 

(a) Facility staff shall help the family or the le- 
gally responsible person in understanding mental 
retardation and other developmental disabilities, 
their child's development, and the extent of the 
child's handicap. 

fb} Individual geal plans shall be dovolopod 
jointly between the facility staff a»4 the child's 
parent ©f the legally responsible; parson whon 
feasible?. 

(b) £e) Family members or the legally responsi- 
ble person shall be provided with the opportunity 
to participate in training seminars. 

(c) (4-) Family members or the legally responsi- 
ble person shall be encouraged to maintain an 
ongoing relationship with their child through 
such means as visits to the facility and the child's 
visits with the parent or the legally responsible 
person outside the facility. 

fe) Reports te- the parent &f the legally re- 
sponsible person shall be submitted at least as- 
nually. R.eports may be m writing ©f take the 
form sf a conference a»4 shall focus ©» the 
child's progress toward meeting individual goals. 

Statutory Authority G.S. 122C-26; 143B-147. 

SECTION .0200 - GROUP HOMES FOR 

INDIVIDUALS WITH MENTAL RETARDATION 

OR OTHER DEVELOPMENTAL DISABILITIES 

AND WITH BEHAVIOR DISORDERS 

.0206 DAY SERVICES 

Day services outside the facility, such as educa- 
tional and vocational training, shall be secured 
for each client as specified m the individual goal 
plan, in accordance with the needs of the client. 

Statutory Authority G.S. 122C-26; 143B-147. 

.0208 BEHAVIORAL PROGRAMMING 
(REPEALED) 

Statutory Authority G.S. I22C-26; I43B-147. 

.0209 COMMUNITY RESOURCES 

h% accordance v4th eaeb client's individual pro- 
gram plan . Community resources shall be utilized 
for each client including recreational, medical, 
dental and religious resources. 

Statutory Authority G.S. 122C-26; I43B-147. 



393 



6:S NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



.0210 PARTICIPATION OF THE FAMILY 

OR LEGALLY RESPONSIBLE PERSON 
(REPEALED) 

Statutory Authority G.S. 122C-26; 143B-147. 

SECTION .0400 - GROUP HOMES FOR 

CHILDREN WITH MENTAL RETARDATION 

OR OTHER DEVELOPMENTAL DISABILITIES 

.0409 COMMUNITY RESOURCES 

Ift accordance with e ach child 'o individual pro 
gram plan, Community resources shall be utilized 
for each child including educational, recreational, 
medical, dental and religious resources. 

Statutory Authority G.S. I22C-26; 143D-147. 

.0410 PARTICIPATION OF THE FAMILY 

OR LEGALLY RESPONSIBLE PERSON 

(a) Staff shall help the family in understanding 
mental retardation and other developmental dis- 
abilities, the child's development, and the extent 
of the child's handicap. 

(fe) Individual geal piano shall be developed 
jointly between the staff a«4 the cliont'o parent 
©f the l e gally responsible person when feasible. 

(b) (e) Family members shall be provided the 
opportunity to participate in training seminars. 

(c) (44 Each family shall be encouraged to 
maintain an ongoing relationship with their child 
through such means as family visits to the facil- 
ity, and the child's visits with the parent or the 
legally responsible person outside the facility. 

(e) Reports t» the parent e* the l e gally re- 
sponsible person shall be submitt e d i» writing at 
least quarterly, when feasible, with the opportu 
ftity- e xtended te the parent e* the legally Fe- 
oponoiblo person for- participation m at least ene 
conforonco annually. 

Statutory Authority G.S. 122C-26; 143B-147. 

SECTION .0600 - ADLLT DEVELOPMENTAL 

ACTIVITY PROGRAMS FOR INDIVIDUALS 

WITH SUBSTANTIAL MENTAL 

RETARDATION: SEVERE PHYSICAL 

DISABILITIES OR OTHER SUBSTANTIAL 

DEVELOPMENTAL DISABILITIES 

.0613 ACCIDENT REPORTING (REPEALED) 

Statutory Authority G.S. 122C-26; MSB- 147. 

.0616 SUSPENSIONS AND DISMISSALS 
(REPEALED) 

Statutory Authority G.S. 122C-26; I43B-147. 



SUBCHAPTER 14N - LICENSURE RULES FOR 
SUBSTANCE ABUSE FACILITIES 

SECTION .0800 - OUTPATIENT METHADONE 

FOR INDIVIDUALS WHO ARE NARCOTIC 

ABUSERS 

.0810 WITHDRAWAL FROM METHADONE 

(a} The withdrawal from methadone shall be 
discussed with each client at the initiation of 
treatment and at three month intervals thereafter. 

fb4 Documentation ef- the discussion required 
i» (a} ef- this Rule a*%4 the client's r e action te the 
discussion shall be recorded m the cliont's record. 

Statutory Authority G.S. 122C-26; I43B-147. 

SUBCHAPTER 140 - LICENSURE RULES FOR 

FACILITIES SERVING MORE THAN ONE 

DISABILITY 

SECTION .0100 - ALTERNATIVE FAMILY 
LIVING 

.0105 CLIENT SUPERVISION 

At least one facility staff member shall be pres- 
ent in the facility during hours in which a client 
is in the facility unless the qualified professional 
who has designated responsibility for the client's 
treatment program or case management plan has 
documented » the individual client plan that 
authorized the client may to remain in the facility 
without supervision, m certain clearly delineated 
instances. 

Statutory Authority G.S. 122C-26; 143B-147. 

.0106 SERVICE RESPONSIBIUITIES 

(a) When the governing body is not the pro- 
vider of services, it shall attempt to match the 
client's needs with the provider. 

(b) Each governing body shall maintain an 
application on each provider which includes the 
following: 

(1) full name of each person living in the fa- 
cility; 

(2) place, telephone number and hours of 
employment for those family members 
who will be providing alternative family 
living services; 

(3) address, directions to and telephone 
number of residence; and 

(4) descriptions of sleeping arrangements for 
the client. 

(c) Each governing body shall have a written 
agreement with each provider which includes but 
is not limited to the following: 

(1) d e scription ef the cli e nt's behavior; the 
responsibility of the provider; 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



394 



PROPOSED RULES 



(2) the responsibilities e£ the provider; 
confidentiality requirements; and 

(3) conlidL'ntiality requirements; responsibility 
and procedures for securing emergency 
services. 

f+f r e sponsibility aft4 procedures fef securing 

emergency semees- 
(44, responsibilities fof supenising the client; 
f6) special dietary considerations; 
(-7} participation t» appropriate training pro 

grama; 
f&) r e sponsibilities ef both parties a* to- p*©- 

vision ©f- client medical, d e ntal, develop 

mental ©f treatment senices a* deemed 

necessary; 
{&} responsibilities fef insuring that the client 

participates » appropriate 

treatment i habilitation senices; 
(-444) responsibilities £©f client transportation; 
(-44) temunation clause; a©4 
(4-34 t e rms ©f compensation. 

(d) Information regarding the client's specific 
needs or conditions shall be given t£ the provider 
pnor to admission. 

(e) (-4-) The governing body shall maintain a 
signed copy of the agreement in the files, and a 
signed copy shall be given to the provider. 

(f) (e4. Each governing body shall furnish each 
provider with a form for recording illness, acci- 
dent or medical concerns, including adminis- 
tration of medication. This form shall be 
maintained by the governing body in the client's 
record. 

Statutory Authority G.S. 122C-26; I43B-147. 

.0108 HOUSEKEEPING ACTIVITIES 

(REPEALED) 
.0109 TRANSPORTATION (REPEALED) 

Statutory Authority G.S. 122C-26; 143B-I47. 

SECTION .0200 - SUPERVISED INDEPENDENT 
LINING 

.0207 TREATMENT/HABILITATION PLAN 
(REPEALED) 

Statutory Authority G.S. I22C-26; I43B-I47. 

SECTION .0300 - RESIDENTIAL THERAPEUTIC 

(HABILITATIVE) CAMPS FOR CHILDREN AND 

ADOLESCENTS 

.0310 PROVISION OE APPROPRIATE 
ACTIVITIES 

Each facility shall provide activities appropriate 
to the functioning level of the child or adolescent. 
Training in language and communication skills, 



fine and gross motor skills, cognitive skills, social 
relationship skills and recreation skills shall be 
provided as specified i» the individual client plan. 
in accordance with the needs of the client. 

Statutory Authority G.S. 122C-26; J43B-/47. 

SECTION .0400 - THERAPEUTIC HOMES FOR 
CHILDREN AND ADOLESCENTS 

.0407 TRAINING OF THERAPEUTIC HOME 
PARENTS 

The individual identified as the therapeutic 
home parent shall receive pre-service training in 
treatment services for the client for whom they 
are providing care. This training shall be docu- 
mented in the personnel files. ©£ the a?ea pro 
gram ©f contract agency. Training shall include, 
but not be limited to, the following: 

(1) child and adolescent development; 

(2) dynamics of emotionally disturbed and 
substance abusing youth and families; 

(3) symptoms of substance abuse; 

(4) needs of emotionally disturbed and sub- 
stance abusing youth in residential settings; 

(5) administration of medication; 

(6) confidentiality; 

(7) client rights; and 

(8) development of the individual treatment 
plan. 

Statutory Authority G.S. 122C-26; I43B-147. 

.0408 AGREEMENT WITH THERAPEUTIC 
HOME PARENTS 

('f \ \\ Tl .-HI till . 1 ; IT .1 T-T-l 1 IT , 1 K A ; 1 t : 1 i~ O il t t K .l J~\ T~ , ~\ ' I ' ' J ."V«* 

©f senices, the governing body a©4 the involved 
providers shall have There shall be a written 
agreement with the therapeutic home parent, 
which includes, but is not limited to, the follow- 
ing: 

(1) responsibility ef the governing body a©4 

the therapeutic home parents; the respon- 
sibility of the provider; 

(2) confidentiality requirements; and 

(3) responsibility and procedures for securing 
emergency senices. 

(-44. terms ©£ compensation; a«4 

(44 availability ©f the therapeutic hom e paf- 
ents, including provision ©£ vacation time 
a©4 period ©f- respit e relief fof the 
therapeutic hom e parents. 

(b) Information regarding the client's specific 
needs or conditions shall b_£ given [o the provider 
pnor to admission. 

(c) (©} A signed copy of the agreement shall be 
maintained m the files ©I the afea program ©f 
contract agency a©4 a copy given to the 
therapeutic home parents. 



395 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



Statutory Authority G.S. I22C-26; 143B-147. 

.0409 COORDINATION OF TREATMENT AND 
EDUCATION 

(a) The area program ef contract agoncy staff 
afi4 therapeutic heme parents client's educational 
program shall coordinat e the client's individual 
be coordinated with his treatment /habilitation 
plan, with his educational program. 

(b) : fhe area program ©f contract ag e ncy staff 
Treatment providers and therapeutic home par- 
ents shall have conferences, at least quarterly, 
consult with teachers or principals regarding the 
client, as well as with juvenile court personnel 
and other relevant caretakers. ¥he cli e nt's parent 

t-\ f <K.> l.n-i III- ■-. i .- »-. r~\ n riKl , i r^. ir, s-\ T-i i • l-i ■ i 1 1 t^^ ni,-li 1,1.1,1 

CTT TTTC rtT^trrT I V. ~ • I ' 1. ' 1 1 J 1 1-' 1 \-> L'V.1 JU 1 1 -J 1 1U 1 I UL 1 I1HJILHJL O 

as indicated by statute afi4 area program ef con 
tract agency staff. 

Statutory Authority G.S. 122C-26; 143B-147. 

.0410 ROLE OF PARENT(S) OR THE 

LEGALLY RESPONSIBLE PERSON 
(REPEALED) 

Statutory Authority G.S. 122C-26; 143B-147. 

SECTION .0600 - SHELTERED WORKSHOPS 

.0610 CLIENT RE-EVALUATION (REPEALED) 

Statutory Authority G.S. I22C-26; I43B-I47. 
.0616 ACCIDENT REPORTING (REPEALED) 

Statutory Authority G.S. 122C-26; 143B-147. 

.0619 SUSPENSIONS AND DISMISSALS 
(REPEALED) 

Statutory Authority G.S. I22C-26; 143B-147. 

CHAPTER 18 - MENTAL HEALTH: OTHER 
PROGRAMS 

SUBCHAPTER 181 - GENERAL 
REQUIREMENTS 

SECTION .0100 - PURPOSE: SCOPE: 
APPLICABILITY AND DEFINITIONS 

.0120 DEFINITIONS 

(a) For the rules contained in Subchapter 181 
through 1 8Q of this Chapter the following defi- 
nitions apply: 

f+4 "Active Client - M e ntal Health Treat 
ment" m e ans treatment provided fof a 
client who: 



(A) has a written plan &f treatm e nt, with 

specific goals an4 time frames; 
(4*4 is receiving tr e atment m accordance 

TTT^TT CT^^ piuiTT ITT ITT 
t ^_ J 1 11UJ 1 1 1 V I 1 U\, \J IU lUt'l. 1 ** 1 1 1 1 CT TTTTTTT I II VI 1 1 l.'l< 1 

within the past 90 days. 
£34 "Activ e Cli e nt - Substance Abuse Treat 

m e nt" moans treatment provid e d fof a 

client who: 
(A) has a writton pteft »f tr e atment, with 

specific goals af*4 time frames; 
fB) is receiving tr e atment i» accordance 

with the plan; a»4 

It \ Vini- m .it t-if fi t ti tt/>^ ^^»tl^ ^ rt ■ i r T q^^^q^J^^t 
( V7 1 IU J x 1 1 \J I IUUU rW TTTC^? TTTTTT CT J LIL1 1 lllLlIll'L'l 

within the past 9© days. 
(3) "Activ e Cli e nt - M e ntal Retardation l±&- 
bihtation" moans developmental pro 
gramming fof a» individual who is 
mentally retarded which is provided under 
the auspices »f the atea program e* its 
contract agencioo a»4 initiated with the 
development ef a» individual program 
plan an4 ceasing when the client ent e rs 

tnllrmi 'il.in/i , ■ t ■ i i i i ■- 
^^^^^^^^^^ t^^^^^^T^ ^ L Ll E \j . i . 

(1) (-4} "Administering Medication" means the 
term as defined in 10 NCAC 14K .0103. 

(2) (-S4 "Affective Education" means teaching 
the individual to work with his own and 
others' feelings and emotions for the pri- 
mary purpose of understanding or modi- 
fying behavior and improving skills for 
making healthy, responsible decisions and 
for communicating effectively. 

(3) (-64 "Alcohol Abuse" means the terms as 
defined in 10 NCAC 14K .0103. 

(4) f?4 "Alcohol Dependence" (alcoholism) 
means the term as defined in 10 NCAC 
14K .0103. 

{5± (S) "APSM 35-1" means "Standard for 
Area Programs and Their Contract Agen- 
cies" as codified in 10 NCAC 181 through 
18Q and published by the Division. 

(6) (4*4 "Area Director" means an employee 
of the area board who is appointed by the 
area board with the approval of the Divi- 
sion director according to the procedures 
delineated in division publication APSR 
105-1. The area director is responsible for 
the appointment of staff, for implementa- 
tion of the policies and programs of the 
Board, compliance with the standards of 
the Commission, and for the supervision 
of all staff and service programs under the 
auspices of the area board. 

(7) (444) "Area Program" means the term as 
defined in 10 NCAC 14K .0103. For 
purposes of these Rules, the term "area 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



396 



PROPOSED RULES 



am 



an 



(12) 

Q3j 

(14) 

(15) 
(16) 

LLZi 



19 



(20} 

(31) 



program" means the same as "area au- 
thority" as defmed in G.S. 122C-3. 
(444 "Assessment" means the term as de- (22) 

fined in 10 NCAC 14K .0103. 
(444 "Atypical development" means the 
term as defined in 10 NCAC 14K .0103. 
(444 "Behavior Modification" means the 
quantifiable application of one or more 
contingencies in a deliberate attempt to 
increase or decrease the frequency of a 
specified action or behavior of an individ- 
ual. 

(44} "Catchment Area" means a ge- 
ographic portion of the state served by a 
specific area mental health, mental retar- 
dation and substance abuse authority as 
specified in 10 NCAC 1SW .0001 - .0003 
(division publication APSR 105-2). 

(444 "Certified alcoholism counselor" 
means an individual who is certified by 
the North Carolina Substance Abuse 
Professional Certification Board. 
(44} "Certified Drug Abuse Counselor" 
means an individual who is certified by 
the North Carolina Substance Abuse 
Professional Certification Board. 
(444 "Certified Substance Abuse Counse- 
lor" means an individual who is certified 
by the North Carolina Substance Abuse 
Professional Certification Board. 
(4-&4 "Child" means the term as defmed in 
10 NCAC 14K .0103. 

(40) "Chronically Mentally 111 Adult" 
means the term as defmed in 10 NCAC 
14K .0103. 

(4(44 "Client Care Evaluation Study" 
means evaluation of the quality of services 
by measuring actual services against spe- 
cific criteria through collection of data, 
identification and justification of vari- 
ations from criteria, analysis of unjustified 
variations, corrective action, and 
follow-up study. 

(-34^ "Clinical Staff Member" means the 
term as defmed in 10 NCAC 14K .0103. 
(44^ "Component" or "Program Compo- 
nent" means a service developed to meet 
a particular need. The program compo- 
nent is provided either through operation 
by the area program or through contract 
with a public or private agency. 
(44) "Contract Agencv" means the term (36) 

as defined in 10 NCAC 14K .0103. 
(44) "Criminal Justice System" means a 
network which includes such elements as 
law enforcement, attorneys, the judiciary, 
adult corrections programs, (including 



(231 
(24) 

(251 
1261 

QZi 

(281 
(29) 

(301 

Oil 

(321 
(33) 
(341 



prisons, probation and parole) and youth 
corrections programs. 
(44) "Day/night Service" means a service 
provided »» a regular basis m a structured 
environment fof a sp e cified portion ef a 
24 hour p e riod fef the purposes ef 
socialization, reintegration k+te the com 
munity, work readiness, rehabilitation, re- 
creation, »f as a» alt e rnative fre- 
hospitalization, the term as defmed in 10 
NCAC 14K .0103. 

(464 "Detoxification" means the term as 
defmed in 10 NCAC 14K .0103. 
(4^4 "Developmentally delayed children" 
means the term as defined in 10 NCAC 
14K .0103. 

(484 "Direct Care Staff' means the term 
as defined in 10 NCAC 14K .0103. 
(444 "Disability Group" means either the 
mentally retarded, mentally ill, or sub- 
stance abusers. 

(444 "Disaster Relief Planning" means ar- 
ranging for the provision of crisis coun- 
seling to survivors of major natural or 
man made catastrophies in accordance 
with the provisions of P.P. 93-288. 
(44-4 "Dispensing Medication" means the 
term as defmed m 10 NCAC 14K .0103. 
(434 "Division" means the same as the 
term "DMH'MR/SAS" as defined in 10 
NCAC 14K .0103. 

(444 "Documentation" means the term as 
defined m 10 NCAC 14K .0103. 
(444 "Drug Abuse" means the term as 
defmed in 10 NCAC 14K .0103. 

(44) "Drug Dependence" (addiction) 
means the term as defined in 10 NCAC 
14K .0103. 

(46) "Early Intervention Services" means 
the term as defmed in 10 NCAC 14K 
.0103. 

(444 "Emergency Service" means an as- 
sessment service which is provided on a 
24-hour non-scheduled basis to individ- 
uals for immediate screening assessment 
of presenting problems. Crisis inter- 
vention or referral to other services are 
provided as indicated. These services may 
be provided either in a hospital or non- 
hospital setting. 

(48) "Eirst Aid" means the term as denned 
in 10 NCAC 14K .0103. 
(4% "Eollow Along" (for mental retarda- 
tion clients) means provision by the 
agency for a continuing relationship with 
the client for the purpose of assuring that 
the client's changing needs are recognized 
and appropriately met. 



397 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



(37) (40) "Foster Parent" means an individual 
who provides substitute care for a planned 
period for a child when his own family or 
legal guardian cannot care for him; and 
who is licensed by the N.C. Department 
of Human Resources and supervised by 
the County Department of Social Services 
or by a private program licensed or ap- 
proved to engage in child care or child 
placing activities. 

(38) (44) "Governing Body" means the term 
as defined in 10 NCAC 14K .0103. 

(39) (43) "He/His/Him" means pronouns used 
throughout these standards for conven- 
ience and consistency for reference to both 
sexes. 

(40) (44) "Health Services" means the term as 
denned in 10 NCAC 14K .0103. 

(41) (44) "High risk children" means the term 
as defmed in 10 NCAC 14K .0103. 

(42) (44) "Hours of Operation" means the 
term as defined in 10 NCAC 14K .0103. 

(46) "Individual Goal Plan" (foe cli e nts with 
mental retardation ef oth e rwise develop 
mentally disabled) means the term a* de- 
fore4 » 444 NCAC 4444 rfr444r 

(4?) "Individual Program Plan" (fee clients 
with mental retardation &f otherwise de- 
v e lopmentally disabled) m e ans the term 
as defined m 44? NCAC 4444 444Q4> 

(43) (48) "Individualized Education Program" 
means a written statement for a child with 
special needs that is developed and imple- 
mented pursuant to 16 NCAC 2E .1500 
(Rules Governing Programs and Services 
for Children with Special Needs) available 
from the Department of Public Instruc- 
tion. 

(49) "Individual Treatment Plan" (fop mental 
health/substance abuse clients) means the 
tern as d e fin e d m 44 NCAC 4444 444444. 

(44) (4*4) "Infant" means the term as defined 
in 10 NCAC 14K .0103. 

(45) (44) "Inpatient service" means a service 
provided in a hospital setting on a 24-hour 
basis under the direction of a physician. 
The service provides continuous, close 
supervision for individuals with moderate 
to severe mental or substance abuse 
problems. 

(46) (43) "Justice Treatment Services" means 
consultation, treatment or educational 
services offered by the area program to 
components of the criminal justice system 
for individuals who have been indicted, 
prosecuted or incarcerated. 

(47) (44) "Legend Drug" means the term as 
defined in 10 NCAC 14K .0103. 



(48) (44) "Medication" means the term as de- 
fined in 10 NCAC 14K .0103. 

(49) (4§) "Minor Client" means the term as 
defined in 10 NCAC 14K .0103. 

(50) (46) "Normalization Principle" means the 
principle of helping individuals to obtain 
an existence as close to normal as possible 
by making available to them patterns and 
conditions of every day life that are as 
close as possible to the norms and pat- 
terns of the mainstream of society. 

(51) (4?) "Nurse" means the term as defined 
in 10 NCAC 14K .0103. 

(52) "Outpatient or outpatient service" means 
the term as defined in H) NCAC 14K 
.0103. 



(53) (48) "Parent" means the term as defined 
in 10 NCAC 14K .0103. 

(54) (49) "Peer Review" means the formal as- 
sessment by professional staff of the qual- 
ity and efficiency of services ordered or 
performed by other professional staff. 

(55) (60) "Periodic Service" means a service 
provided through short recurring visits fef 
individuals who aee mentally illr mentally 
retarded &f substanc e abusers who ea» 
function m their normal environment. 
the term as defined in 10 NCAC 14K 
.0103. 



(56) (64) "Preschool age child" means the term 
as defined in 10 NCAC 14K .0103. 

(57) (63) "Prevention/intervention Service" 
means a service provided to the general 
public or major segments of a commu- 
nity. Service activities include counseling, 
information, instruction, and technical as- 
sistance with the goals of preventing 
dysfunction and promoting well being. 

(58) (64) "Privileging" means a process by 
which each staff member's credentials, 
training and experience are examined and 
a determination made as to which 
treatment/habilitation modalities he is 
qualified to provide. 

(59) (64) "Program Evaluation" means the 
term as defined in 10 NCAC 14K .0103. 

(60) (64) "Psychiatric Nurse" means the term 
as defined in 10 NCAC 14K .0103. 

(61) (46) "Psychiatric Social Worker" means 
the term as defined in 10 NCAC 14K 
.0103. 

(62) (63) "Psychiatrist" means the term as de- 
fined in 10 NCAC 14K .0103. 

(63) (48) "Psychotherapy" means the term as 
defined in 10 NCAC 14K .0103. 

(64) (60) "Psychotropic Medication" means 
the term as defined in 10 NCAC 14K 
.0103. 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



39,S 



PROPOSED RULES 



(65) fTO) "Qualified Alcoholism Professional" 
means the term as defined in 10 NCAC 
14K .0103. 

(66) (^744 "Qualified Client Record Manager" 
means an individual who is a graduate of 
a curriculum accredited by the Council on 
Medical Education and Registration of 
the American Medical Record Associ- 
ation and who is currently registered or 
accredited by the American Medical Re- 
cord Association. 

(67) (33) "Qualified Drug Abuse Professional" 
means the term as defined in 10 NCAC 
14K .0103. 

(68) f34) "Qualified Mental Health Profes- 
sional" means the term as defined in 10 
NCAC 14K .0103. 

(69) (34) "Qualified Mental Retardation Pro- 
fessional" means the same as the term 
"Qualified developmental disabilities pro- 
fessional" as defined in 10 NCAC 14K 
.0103. 

(70) (35) "Qualified Nutritionist" means the 
term as defined in 10 NCAC 14K .0103. 

(71) (36) "Qualified Substance Abuse Profes- 
sional" means the term as defined in 10 
NCAC 14K .0103. 

(72) f33} "Registered Dietitian" means the 
term as defined in 10 NCAC 14K .0103. 

(73) (38) "Rehabilitation" means the term as 
defined in 10 NCAC 14K .0103. 

(74) f74H "Research" means the term as de- 
fined in 10 NCAC 14K .0103. 

(75) fSOf "Research Review Board" means a 
group comprised of at least five members 
which has the authority to approve, re- 
quire modification, or disapprove pro- 
posed research projects of the area 
program or its contract agencies. Indi- 
viduals not directly associated with re- 
search projects under consideration 
comprise a majority of the review board. 
The review board may be established by 
the program conducting research activities 
or by another public or private agency, 
institution or organization. 

(76) f84) "Residential Service" means a service 
provided in a 24-hour living environment 
in a non-hospital setting where room, 
board, and supervision are an integral part 
of the care, treatment, habilitation or re- 
habilitation provided the individual. 

(77) (&2) "Respite episode" means the term as 
defined in 10 NCAC 14K .0103. 

(78) f££) "Screening" means the term as de- 
fined in 10 NCAC 14K .0103. 

(79) "Service" means the term as defined in 
10 NCAC 14K .0103. 



80) 



(81} 



L^> 



[83} 
[84} 



(85 



[86] 

(87) 

(88) 



m. 

[90} 
(91) 
(92) 



(£44 "Severely Physically Disabled 
Person" means for the purpose of ADAP 
(Adult Developmental Activity Program) 
the term as defined in 10 NCAC 14K 
.0103. 

(&§) "Standard Client Record" means a 
written account of all services provided a 
client from the time of formal aoooptanco 
admission of the client by the area pro- 
gram or contract agency until termination 
»f i jorvicos. discharge. This information 
is documented on standard forms which 
are filed in a standard order. 
(£6) "Standards" means specifications of 
the required basic levels of activity and 
required basic levels of human and tech- 
nical resources necessary for the imple- 
mentation and operation of mental health, 
mental retardation and substance abuse 
programs. Standards are officially titled 
"Standards for Area Programs and Their 
Contract Agencies", are codified in 10 
NCAC 181 through 18Q and are pub- 
lished by the Division as APSM 35-1. 
(£34, "State Facility" means a facility op- 
erated by the Division and which provides 
mental health, mental retardation or sub- 
stance abuse services. 
(&£4 "Student" means an individual who 
is participating in a prescribed course of 
instruction, for example, an individual 
who is enrolled in an alcohol and drug 
education traffic school or a drug educa- 
tion school. 

f&Of "Substantially Mentally Retarded 
Person" means the term as defined in 10 
NCAC 14K .0103. 

(OQ) "Support Services" means the term 
as defined in 10 NCAC 14K .0103. 

(-944 "Telephone Counseling Service" 
means an organized and publicized service 
providing short-term supportive coun- 
seling, referral, crisis intervention and in- 
formation. 

fJ-34- "Testing Services" means the admin- 
istration and interpretation of the results 
of standardized instruments for the as- 
sessment, diagnosis or evaluation of psy- 
chological or developmental disorders. 
(&4) "Toddler" means the term as defined 
in 10 NCAC 14K .0103. 

"Treatment habilitation plan" means the 
term as defined m W NCAC 14K .0103. 

"Twentv-four hour service" means the 
term as defined in 10 NCAC 14k .0103. 



{$4} "Utilization Review" means exam- 
ination of the appropriateness of admis- 
sion, services ordered and provided, length 



399 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



of treatment and discharge practice usu- 
ally on a concurrent basis. Utilization 
review focuses upon the individual client. 
(93) (#£} "Vocational Rehabilitation Services" 
means services available to eligible men- 
tally and physically disabled citizens who, 
with reasonable accommodations, can 
perform the essential function of the job 
in question as defined in the Rehabili- 
tation Act of 1973 (P.L. 93-112 as 
amended), 
(b) In addition to the definitions contained in 
this rule, the terms defined in G.S. 122C-3 also 
apply to all the rules in this Subchapter and 
Subchapters 18J through 18Q of this Chapter. 

Statutory Authority G.S. 122C-3; 143B-147. 

SUBCHAPTER 18L - PROGRAM COMPONENT 
OPERATIONAL STANDARDS 



The standards in this Section apply to each 
component service of the area program and its 
contract agencies, unless otherwise spocifi e d » 
the "Sorvico Records Manual fop Area Operated 
an4 Contract Agency Components" (division 
publication APSM ' 15 2). Thoso referenced rules 
have boon adopted i» accordance with G.S. 
15QB 11(c). 

Statutory Authority G.S. 143B-147. 

.0702 CROSS-REFERENCE TO ADMISSION 
AND DISCHARGE 

(a) Each component service not subject to 
licensure under G.S. 122C, Article 2 shall comply 
with the provisions of 10 NCAC 14K .0313. 

(b) For purposes of the rules of this Section, 
the term "faculty" in 10 NCAC 14K .0313 shall 
be interpreted to mean "component". 
"service". 



SECTION .0500 - CLIENT RECORDS 

.0505 CLIENT RECORD RESPONSIBILITY 

(REPEALED) 
.0506 STANDARD Mil RECORD FOR AREA 

OPERATED COMPONENTS (REPEALED) 
.0507 STANDARD SA RECORD FOR AREA 

OPERATED COMPONENTS (REPEALED) 
.0508 STANDARD MR RECORD FOR AREA 

OPERATED COMPONENTS (REPEALED) 
.0509 STANDARD MH/MR/SA RECORDS FOR 

CONTRACT AGENCIES (REPEALED) 
.0510 CONTENT FOR CLIENT RECORDS 

(REPEALED) 

Statutory Authority G.S. 122C-51; 122C-57; 
122C-6I; 122C-206; I43B-147. 

.0512 INDICES AND REGISTERS 
(REPEALED) 

Statutory Authority G.S. 143B-147. 

SECTION .0600 - CLIENT ELIGIBILITY 

.0603 SERVICE PURPOSE AND ELIGIBILITY 
REQUIREMENTS 

The governing body ©f e ach component shall 
develop written policies addressing it* the pur- 
pose and eligibility for service requirements, m- 
cluding admission, treatment ■ habitation a«4 
disohargo crit e ria. 

Statutory Authority G.S. 143B-147. 

SECTION .0700 - TREATMENT/HAB1LITATION 
PROCESS 

.0701 SCOPE 



Statutory Authority G.S. 143B-147. 

.0706 CROSS-REFERENCE TO DISCHARGE 
/AFTERCARE (REPEALED) 

Statutory Authority G.S. 143B-I47. 

SECTION .0800 - HEALTH PRACTICES 

.0802 PHYSICIAN ASSESSMENT (REPEALED) 

Statutory Authority G.S. 122C-51; 122C-117; 
122C-121; 122C-154; 122C-I55; 1 43 B- 147. 

.0806 CROSS-REFERENCE TO EMERGENCY 
CARE PERMISSION 

(a) Upon the client 's admission, Each compo 
nent facility not subject to licensure under G.S. 
122C, Article 2 shall comply with the provisions 
of 10 NCAC 14K .0337. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0337 shall 
be interpreted to mean "component". 
"service". 

Statutory Authority G.S. 143B-147. 

SECTION .1 100 - MEDICATION SERVICES 

.1102 CROSS-REFERENCE TO PRESCRIBING 
OF MEDICATION 

(a) Individuals prescribing or administering 
medication in programs not subject to licensure 
under G.S. 122C, Article 2 shall comply with the 
provisions of W NCAC 4444 44440, 10 NCAC 
14K .0351. 

(b) For purposes of the rules of this Section, 
the term "faculties" in 44) NCAC 44+4 4444a 10 



6:8 NORTH CAROLINA REGISTER July 15, 1 99 1 



400 



PROPOSED RULES 



NCAC 14K .0351 shall be interpreted to mean 



Statutory Authority G.S. 143B-I47. 

.1 104 CROSS-REFERENCE TO 

ADMINISTRATION OF MEDICATION 
(REPEALED) 

Statutory Authority G.S. 90-21.5; 90-171.20 (7), 
(8); 90-177.44; 143B-147. 

SECTION .1500 - EARLY INTERVENTION 
SERVICES PROCEDURE SAFEGUARDS 

.1502 DEFINITIONS 

(a) As used in this Section, the following terms 
shall have the meanings specified in Section 
303.401 of Subpart E of Part 303 of Title 34 of 
the Code of Federal Regulations: 

(1) "Consent"; 

(2) "Native language"; 

(3) "Personally identifiable". 

This adoption by reference is in accordance with 
G.S. 150B- 14(c). 

(b) As used in this Section, the term "Early 
Intervention Services" shall have the meaning 
specified in Section 303.12 of Subpart A of Part 
303 of Title 34 of the Code of Federal Regu- 
lations. This adoption by reference is in accord- 
ance with G.S. 1 SOB- 14(c). 

(c) As used in this Section, an eligible child is 
an infant or toddler with &f at risk fof develop 
mental disabilities, delays, e* atypical develop 
ment who meets the definition of "high risk 
children." as defined in 10 NCAC 14K .0103. 
This adoption by reference is in accordance with 
G.S. 150B-14(c). 



Authority G.S. 143B-147; 1 SOB- 1(d); 
Sections 1401 et. seq., 147 1 et. seq. 



20 U.S.C. 



.1507 EARLY INTERVENTION SERVICES 

(a) Area programs and contract agencies shall 
comply with Section 303.12 (b) through (e) of 
Subpart A of Part 303 of Title 34 of the Code of 
Federal Regulations relating to early intervention 
services. This adoption bv reference is in ac- 
cordance with G.S. 1-50B- 14(c). 

(b) Infants and toddlers referred for services 
shall be assessed m accordance with the pro- 
visions of J_0 NCAC 14K. .0314 and admitted in 
accordance with the provisions of j_0 NCAC 14K 
.0313. 

(c) Infants and toddlers shall receive services in 
accordance with the provisions of 10 NCAC 14K 
.0315. 



Authority G.S. 143B-147; I50B-I(d); 20 U.S.C. 
Sections 1401 et. seq., 1471 et.seq. 

SUBCHAPTER ISM - REQUIRED SERVICES 

SECTION .0300 - CONSULTATION AND 

EDUCATION SERVICES FOR INDIVIDUALS 

OF ALL DISABILITY GROUPS 

.0308 MAINTENANCE AND RETENTION OF 
RECORDS 

Statutory Authority G.S. 143B-147. 

SECTION .0700 - DEVELOPMENTAL DAY 

SERVICES FOR PRESCHOOL CHILDREN 

WITH DEVELOPMENTAL DISABILITIES OR 

DELAYS OR AT HIGH RISK FOR MENTAL 

RETARDATION, DEVELOPMENTAL 

DISABILITIES OR DELAYS 

.0704 STAFF REQUIREMENTS 

(a) Staff shall provide continuous supervision 
of each child. 

(b) A minimum of two staff members shall 
provide direct child care at all times. 

(c) A minimum of one direct child care staff 
member shall be on duty for each five children. 

(d) A minimum of one certified teacher who 
holds certification in special education, early 
childhood education or elementary education 
shall be employed for each 20 children or less. 
When infants and toddlers are served, the pro- 
fessional responsible for fulfilling this require- 
ment shall be privileged according te- the 
procedures outlined i» the Division's R.EGU 
LATION'S FOR- PRIVILEGING PROFES 
SIONALS WORKING WITH INFANTS 
A4vD TODDI ERS WITH OR Xf- R4SK- FOR 
DFVFI OPMFNTAL DELAYS OR ATYPI 
OAF- DEVFLOPMFNT. APSM F3Q-4- ( 1 , 1 89). 
This manual is adopted by- r e ferenc e in- accord 
anee with G.S. 150B M(c). in accordance with 
a written agreement between the Division and the 
area program. 

(e) If infants are served, a minimum of one di- 
rect care staff member shall be on duty for each 
three infants. 

(£)• Assessment ef- the child to determine devel 
opmental delay, developmental disability, atypi 
eal development »f high risk tof th e s e conditions 
shall be performed bv a professional privileged 
according to procedur e s outlined m the Divi 
stofr* REGULATION FOR PRIVILEGING 
PROFESSIONALS WORKING WITH FN- 
FANTS A4CD TODDLFRS WITH OR A* 
RfcvK FOR- DEVELOPMENTAL DELAYS 
©ft ATYPICAL DEVELOPMENT, APSM 
120 1 ( . 1. ESQ) whose training includes assessing 
children » the developmental *fea rf concern. 



401 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



Statutory Authority G.S. 143B-I47. 

.0707 INDIVIDUAL PROGRAM PLANS AND 
GOAL PLANS (REPEALED) 



certify the eligibility of each client for the 
ADAP service taking into consideration 
at least the provision of Paragraph (b) and 
Subparagraphs (d)(1) and (d)(2) of this 
Standard. Rule. 



Statutory Authority G.S. J22C-5I; I43B-147. 

.0710 FAMILY SERVICES 

(a) Individual geal plans shall be shared with 
parents se that- the family may- continue training 
activities. 

(a) (b) Parents shall be provided the opportu- 
nity to observe their child in the program. 

(b) (e) The center shall provide or secure op- 
portunities for parents to attend parent training 
seminars. 

(4) Reports te- parents shall be submitted at 
least every throo months. Reports may be m 
writing ©f take the form ©f a conference, as4 
shall focus ©» the child's progress. 

Statutory Authority G.S. 122C-5I; 143B-147. 

SECTION .0800 - ADULT DEVELOPMENTAL 

ACTIVITY PROGRAMS (ADAP) FOR 

INDIVIDUALS WITH SUBSTANTIAL MENTAL 

RETARDATION, SEN ERE PHYSICAL 

DISABILITIES OR OTHER SUBSTANTIAL 

DEVELOPMENTAL DISABILITIES 



.0818 



AND 



ADMISSION CRITERIA 
PROCEDURES 

(a) Each ADAP shall have an admissions 
committee. 

(b) A pre-admission staffing shall be held for 
each client considered for admission to the 
ADAP. During the staffing, the committee shall 
consider information available regarding the cli- 
ent's medical, psychological and social histories. 

(c) Results of the pre-admission staffing shall 
be documented ae4 forwarded provided to the 
referral agency. A representative of the ADAP 
admissions committee shall notify the client. 

(d) Each ADAP shall have written admission 
policies and procedures. These policies and 
procedures shall include at least the following: 

(1) Each client shall be referred to the Divi- 
sion of Vocational Rehabilitation Ser- 
vices, with written documentation ©£ this 
referral. 

(2) A qualified mental retardation professional 
of the area program shall obtain a written 
recommendation from the vocational re- 
habilitation counselor recommending 
consideration for a placement in the 
ADAP. 

(3) A qualified developmental disabilities 
professional of the area program shall 



Statutory Authority G.S. 122C-5I; I43B-147. 

SECTION .1 100 - INPATIENT HOSPITAL 

DETOXIFICATION SERVICES FOR 

INDIVIDUALS WHO ARE ALCOHOL OR 

OTHER DRUG ABUSERS 

.1 105 AREA PROGRAM WRITTEN 
AGREEMENTS 

When inpatient hospital detoxification services 
are provided by written agreement with a private 
or general hospital, the written agreement shall 
be developed between the area program and the 
service provider which shall specify at least the 
following: 

(1) criteria for service availability for area pro- 
gram patients; 

(2) responsibilities of both parties related to 
admission, treatment and discharge of pa- 
tients; 

(3) parties responsible for the operation of the 
detoxification service; 

(4) responsibilities of each party regarding 
continuity of service for patients discharged 
from the detoxification service; and 

(5) provision for the exchange of information 
including at least a transfer ©f discharge 
summary, between the area program and the 
inpatient service. 

Statutory Authority G.S. I43B-147. 

SECTION .1400 - EARLY CHILDHOOD 

INTERVENTION SERVICES (ECIS) FOR 

CHILDREN WITH MENTAL RETARDATION 

OR AT HIGH RISK FOR MENTAL 

RETARDATION OR OTHER 

DEVELOPMENTAL DISABILITIES OR DELAYS 

.1403 INTERDISCIPLINARY ECIS STAFF 

(a) At least one member of the ECIS staff shall 
be an individual who holds a degree in education 
or early childhood development. 

(b) The disciplines of social work, physical 
therapy, occupational therapy and medicine shall 
be represented on the staff in response to the 
documented needs of the children and families 
served. These disciplines may be represented by 
staff members, consultant staff, or through 
agreements with staff of other agencies. 

(c) Assessment ©f the child t©- determine devel 
opmental delay, developmental disability, atypi 
eal development ©f high fisk- f-©f these conditions 
shall be p e rformed by- a» appropriately privileged 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



402 



PROPOSED RULES 



professional privileged according to toe proce 
dures outlined m toe Division's R.EGL.T.ATION 
j^Oft PRIVILEGING PROFESSIONALS 
WORKING WITH INFANTS A-X© 
TODDLERS WITH OR AT «TvK- LTAR- BE- 
VF1 OPMENTAL DELAYS Oft ATYPICAL 
DEVELOPMENT, APSM 4^0-4 (4/1/89) 
wkese training includes assessing children to toe 
developmental apea el concern. Assessments 
shall he conducted in accordance with 10 NCAC 
I4K .0314. 



Authority G.S. I43B-I47; 20 L'.S.C. 1471. 

.1405 INDIVIDUAL TREATMENT/ 
HABILITATION PLAN 

fto Individual program plans, with individual 
quarterly seal plans, shall be developed with toe 
parent fof each child. 

£b} Individual quarterly g€*4 plans shall address 
the developmental areas ef self help, physical, 
language afto speech, cognitive. afto psychosocial 
skills a* indicat e d by needs identified to toe child 
ass e ssment process a»4 par e ntal priorities. 

(to Each review to toe child's progress shall be 
conducted by toe ECIS s+aff as4 toe child's pa*- 
estor 

(Tf Individual parent program plans with indi 
vidual quarterly seto plans shall be dev e loped 
with toe parents e* legally responsible person to 
toe children served Bf- m areas indicated by- needs 
identified to toe family assessment process. This 
process involves gathering information about 
family strengths a«4 needs relat e d to th e ir ability 
to enhance their child's development. 

(-e+ Standardised tests, rating scales, develop 
mental profiles a»4 other instruments afto pro 
cedures toto meet acceptable professional 
standards shall be us e d to document toe nature 
afto seventy to toe problem necessitating inter 
vention. 

.An individual treatment habilitation plan shall 
be developed in the same format and content as 
that required bv 10 NCAC UK .0315. 



Authority G.S. 
1471. 



122C-51; 143B-14' 7 ; 20 L.S.C. 



SUBCHAPTER I8N - OPTIONAL SERVICES 

FOR INDIVIDUALS OF ALL DISABILITY 

GROLPS 

SECTION .0200 - SPECIALIZED FOSTER CARE 
SERVICES 

.0212 SUPPORT ACTIVITIES OF THE 
AREA PROGRAM 

Support activities of the area program shall in- 
clude the following: 



(1) assistance with funding, including billing 
preparation: 

(2) monitoring and evaluation of service activ- 
ities identified within the placement care 
agreement; 

(3) consultation and technical assistance; 

(4) coordination of initial and ongoing training 
for specialized foster parents: 

(5) coordination of activities with the county 
department of social services or other li- 
censed child care agency to assure that con- 
sistent and mutually agreeable requirements 
are placed on the foster parents: 

(6) facilitation of specialized support services 
for the foster family and child including day 
services, respite care, and continuing diag- 
nostic and evaluation services; and 

(34. l e ad e rship to toe development afto implo 
mentation to toe individual tr e atment 
quarterly geto plan afto toe completion to 
progress revi e ws: a«4 

(7) fS* assistance to the county department of 
social services or other licensed child care 
agency in the event of change of foster 
placement. 

Statutory Authority G.S. 122C-51; 143B-147. 

SECTION .0300 - PREVENTION SERVICES FOR 
INDIVIDUALS OF ALL DISABILITY GROLPS 

.0307 DATA COLLECTION, MAINTENANCE 
AND RETENTION (REPEALED) 

Statutory Authority G.S. 143B-147. 

SUBCHAPTER ISO - OPTIONAL SERVICES 

FOR INDIVIDUALS WHO ARE SUBSTANCE 

ABUSERS 

SECTION .0500 - TREATMENT ALTERNATIVES 

TO STREET CRIMES (TASC) FOR 

INDIVIDUALS WHO ARE SUBSTANCE 

ABUSERS 

.0520 SCREENING AND IDENTIFICATION 

Each TASC program shall provide to the crim- 
inal justice system documented screening and 
identification for prospective clients, interviewed 
which shall include toe following: 

fb) substance abus e history: 

(4) cnminal history: 

to* demographic information: afto 

f+> current employment a*to jeb status. 

Statutory Authority G.S. 122C-5": 143B-147. 

.0521 EVALUATION 

Each TASC program shall conduct or secure a 
substanc e abuse an assessment or evaluation for 



403 



6:S NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



each prospective client referred from the criminal 
justice system, which shall include the following: 

(44 domographic information; 

(3) social summary; 

(34 current aa4 past subotanoo abus e pattomo 



with roforoncoo te sp e cific substances 
(4) length &f substanc e abuse; aad 
(4) frequency ef substance abuse. 

Statutory Authority G.S. I22C-57; 143B-147. 

.0523 MONITORING/REPORTING 
(a) Each TASC program shall develop and im- 
plement a monitoring and reporting procedure 
for each client. 

(fe4 ?4ie monitoring procedure shall include as 
a minimum the following: 
(44 chang e » residence; 
change » l e gal status; 
changes » employment a«4 education; 
attendance; 



(64 



program participation; 

urinalysis; 

treatment modality assignment; S&4 

progress ef treatment goals. 
Each TASC program shall provide regular 
reports regarding oach client te the courts a»4 
approved individuals e* agoncios. 



Statutory Authority G.S. I22C-57; 143B-147. 

SUBCHAPTER 18P - OPTIONAL SERVICES 

FOR INDIVIDUALS WHO ARE MENTALLY ILL 

OR EMOTIONALLY DISTURBED 

SECTION .0900 - CONTRACTED INPATIENT 
PSYCHIATRIC SERVICES FOR CHILDREN: 

ADOLESCENT: ADULT AND ELDERLY 
INDIVIDUALS WHO ARE MENTALLY ILL 

.0903 AREA PROGRAM/HOSPITAL 
AGREEMENT 

(a) A written agreement between the area pro- 
gram and the general hospital or private psychi- 
atric hospital shall be developed and shall specify 
at least the following: 

( 1 ) criteria for service availability for area 
program patients; 

(2) responsibilities of both parties related to 
admission, treatment, and discharge of 
patients; 

(3) parties responsible for the operation of the 
inpatient service; 

(4) responsibilities of each party regarding 
continuity of service for patients dis- 
charged from the inpatient service; and 

(5) provision for the exchange of information. 
including at l e ast a discharge summary, 



between the a*ea program a»4 the inpa 
tiont service. 
(b) The written agreement shall be approved 
by the Division. 

Statutory Authority G.S. 122C-5I; 143B-I47. 

SUBCHAPTER 18Q - GROUP HOMES FOR 

ADULTS WITH MENTAL RETARDATION OR 

OTHER DEVELOPMENTAL DISABILITIES 

SECTION .0500 - COMMUNITY RESPITE 

SERVICES FOR INDIVIDUALS WITH MENTAL 

RETARDATION, OTHER DEVELOPMENTAL 

DISABILITIES, DEVELOPMENTAL DELAYS 

OR AT RISK FOR THESE CONDITIONS 

.0541 COMPANION SITTER: 
RESPONSIBILITIES OF 
GOVERNING BODY 

(a) Each governing body shall attempt to 
match the client's needs with the provider's abil- 
ity to provide respite care. 

(b) Each governing body shall make available 
to the provider a written statement of duties and 
responsibilities: 

(1) This statement shall include length of ser- 
vice to be provided, medications to be 
administered and special dietary consider- 
ations. 

(2) If the client is involved in a developmental 
or occupational program, the provider 
shall be provided written information re- 
garding his responsibilities for assuring 
that the client attends the program and for 
structuring activities to enhance objectives 
established by the developmental or oc- 
cupational program. 

(e) Each governing body shall mako availablo 
te- the provider a form fof recording illness, acci 
dent , m e dical concern, including administration 
ef- medication, as4 gen e ral h e alth a«4 appoaranco 
ef- each client at the initiation ©f each e pisode e4 
respite caro. Following each respite episode, the 
companion sitter facility shall forward the com 
pleted form te the governing body fes inclusion 
m the client's record. 

Statutory Authority G.S. 143B-I47. 

SECTION .0800 - APARTMENT LIVING 

PROGRAMS FOR ADULTS WITH MENTAL 

RETARDATION OR OTHER 

DEVELOPMENTAL DISABILITIES 

.0808 CROSS-REFERENCE TO TREATMENT 
/HABILITATION PLAN 

Each apartment living program not subject to 
licensure under G.S. 122C, Article 2 shall comply 
with the requirements regarding the develop a 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



404 



PROPOSED RULES 



treatment habilitation plan delineated utilizing 
the same format and content as is required in 10 
NCAC 4-40 rimir ]4K .0315. 

Statutory Authority G.S. 143B-147. 

.0809 AGREEMENT BETWEEN RESIDENT 
AND PROGRAM 

(a) A written agreement shall be negotiated 
between each resident and the apartment living 
program which specifies the responsibilities of the 
program and the resident. 

ffe-f On e copy shall be gives to the r e oidont aa4 
**»e copy included m th# rj ' .ddijnt'o rooord. 

(b) (-e-f The agreement shall be renegotiated as 
appropriate but at least annually. 

Statutory: Authority G.S. 122C-51; 143B-147. 

****************** 



lyotice is hereby given in accordance with G.S. 
I SOB- 12 that the Commission for Mental Health, 
Developmental Disabilities and Substance Abuse 
Sen-ices intends to amend rule(s) cited as 10 
NCAC 14P .0101 - .0102; 14Q .0101 - .0104, 
.0201 - .0204, .0301 - .0306; 14R .0101 - .0107, 
.0201, .0301 - .0303; 14S .0101 - .0106; 18L .0433 
- .0434: and repeal rule(s) cited as 10 NCAC 14K 
.0366 - .0367; ISO .0713, .08/2. 

1 he proposed effective date of this action is De- 
cember 1, 1991. 

1 he public hearing will be conducted at 10:00 
a.m. on August 14. 1991 at the Mission Valley 
Inn, 31 10 Avent Fern' Rd., Raleigh, NC 27606, 
(919) S2S-3173. 

Comment Procedures: Any interested person 
may present his comments by oral presentation or 
by submitting a written statement. Persons wish- 
ing to make oral presentations should contact 
Marilyn Brothers, Division of Mental Health. De- 
velopmental Disabilities and Substance Abuse 
Services, 325 N. Salisbury St.. Raleigh, NC 
27603, (919) 733-4774 by August 13, 1991. 
Written comments must be sent to the above ad- 
dress and must state the rule(s) to which the 
comments are addressed. Fiscal information on 
these rides is also available from the same address. 

CHAPTER 14 - MENTAL HEALTH: GENERAL 

SUBCHAPTER 14K - CORE LICENSURE RULES 

FOR MENTAL HEALTH: MENTAL 

RETARDATION AND OTHER 



DEVELOPMENTAL DISABILITIES: AND 
SUBSTANCE ABUSE FACILITIES 

SECTION .0300 - FACILITY AND PROGRAM 
MANAGEMENT 

.0366 APPLICABLE CLIENTS' RIGHTS 

STATUTES (REPEALED) 
.0367 USE OF INTERVENTION PROCEDURES 

(REPEALED) 

Statutory Authority G.S. 122C-26; J22C-51; 

122C-51 through I22C-62; 122C-53; 122C-60; 

122C-65; 122C-66; BOA- 143; 131E-67; 
143B-I47. 

SUBCHAPTER 14P - PROCEDURES AND 
GENERAL INFORMATION 

SECTION .0100 - SCOPE AND DEFINITIONS 

.0101 SCOPE 

These Rules, 10 NCAC 14P. 14Q, 14R and 
14S, set forth procedures governing the pro- 
tection of client rights in public and private fa- 
cilities providing mental health, developmental 
disabilities and substance abuse services, with the 
exception of state-operated facilities. In addition 
to these Rules, the governing body shall comply 
with the provisions of G.S. 122C, Article 3, re- 
garding client rights. 



Statutory Authority G.S. 
I43B-17; 143B-147. 



I22C-51; 131E-67, 



.0102 DEFINITIONS 

(a) I» addition to The definitions contained in 
this Rule, and the terms defined in G.S. 122C-3, 
G.S. 122C-4 and G.S. 122C- 53(f) also apply to 
all rules in Subchapters 14P, 14Q, 14R and 14S. 

(b) As used in these Rules, the following terms 
have the meanings specified: 

(1) "Abuse" means the infliction of physical 
»f mental mental or physical pain or in- 
jury by other than accidental means, or 
unreasonable confinement, or the depri- 
vation by an employee of services which 
are necessary to the mental and physical 
health of the client. Temporary discom- 
fort that is part of an approved and docu- 
mented treatment plan or use of a 
documented emergency procedure shall 
not be considered abuse. 

(2) "Basic necessities" means the essential 
items or substances needed to support life 
and health which include, but are not 
limited to, a nutritionally sound diet bal- 
anced during consisting of three meals per 
day, access to water and bathroom facili- 
ties at frequent intervals, seasonable 



405 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



clothing, medications prescribed by a 
physician, time for sleeping and frequent 
access to social contacts. 

(3) "Consent" means concurrence by a client 
or legally responsible person following re- 
ceipt of sufficient information by from the 
qualified professional who will administer 
the proposed treatment or procedure. 
Informed Consent implies that the client 
or legally responsible person was provided 
with sufficient information concerning 
proposed treatment, including both bene- 
fits and risks, in order to make a» odu 
catod a decision with regard to such 
treatment. 

(4) "Dangorous articloo &f substanc e s" 
moans, bto is net limited tor a»y weapon 
e* potential weapon, heavy blunt object, 
sharp objects, potentially harmful chemi 
eato, ©f drugs ©f aay sertr including alco 

(4) (4) "Director of Clinical Services" means 
medical director, Director of Medical Ser- 
vices, or other qualified professional des- 
ignated by the governing body as the 
Director of Clinical Services. et a 
designee. 

(5) (4) "Emergency" means a situation in 
which a client is in imminent danger of 
causing abuse or injury to self or others 
or when substantial property damage is 
occurring as a result of unexpected and 
severe forms of inappropriate behavior 
and rapid intervention by the staff is 
needed. 

(6) (4) "Exclusionary time-out" means the 
removal of a client to a separate area or 
room from which exit is not barred, for 
the purpose of modifying behavior. 

(7) (-&) "Exploitation" means the illegal or 
impropor unauthorized use of a client or 
a client's resources for another person's 
profit, business or advantage. The term 
includes taking or using personal property 
from a client with or without the client's 
permission. 

(8) (4) "Governing body" means those pef- 
sons e? a designee, any person who by 
law, charter, articles of incorporation, 
partnership agreement, or other legally 
recognized manner have full legal author- 
ity for the overall operation of the facility. 

(9) (44) "Governor's Advocacy Council for 
Persons with Disabilities (GACPD)" 
means a the council legislatively mandated 
by steto gov e rnment to provide protection 
and advocacy systems and promote em- 



ployment for all persons with disabilities 
in North Carolina. 

(10) (44) "Intervention Advisory Committee" 
means a group of three to five concerned 
citizens established by the governing body 
to provide an additional safeguard in fa- 
cilities a facility that utilise utilizes intru- 
sive treatment or habilitation 
interventions specified in Subchapter 44R 
E*4e4}446r Subchapter 14R .0106. 

(11) (45) "Intervention procedures" refers to 
means the following interventions: seclu- 
sion; physical restraint, excluding protec- 
tive device; isolation time-out; 
exclusionary time-out for more than 15 
minutes; time-out for more than one 
hour; contingent withdrawal or delay of 
access to personal possessions or goods to 
which the client is ordinarily entitled; 
consistent deprivation of items or cessa- 
tion of an activity which the client is 
scheduled to receive (other than basic ne- 
cessities); and overcorrection to which the 
client resists, is likely to resist. 

( 12) (44) "Intrusive intervention" refers to 
means an intervention procedure which 
presents a significant risk of mental or 
physical harm to the client and, therefore, 
requires additional safeguards. Such an 
intervention may include the use of: 

(A) seclusion; physical restraint, excluding 
protective device; or isolation time-out 
employed as a measure of therapeutic 
treatment; and 

(B) seclusion; restraint, excluding protective 
device; or isolation time-out used on an 
emergency basis for more than 40 hours 
in a calendar month or for more than one 
episode of 24 hours. 

( 13) "Involuntary client" means an individual 
who is admitted to a facility in accordance 
with G.S. 122C, Article 5, Parts 6 through 

Hi 

(14) "Isolation time-out" means the removal 

of a client to a separate room from which 
exit is barred but not locked and where 
there is continuous supervision by staff, 
for the purpose of modifying behavior. 
(44) "Major physical injury" means damago 
caused to the body resulting m substantial 
bleeding »f contusion ef tissues, fractur e 
ef a bone, damago to internal organs, toss 
ef consciousness, toss ef normal 
neurological function (inability to move 
©f coordinate mov e m e nt) ef any other 
painful condition caused by such injury. 

(15) (44) "Minor client" means a person under 
1 8 years of age who has not been married 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



406 



PROPOSED RULES 



or who has not been emancipated by a 
decree issued by a court of competent ju- 
risdiction or is not a member of the armed 
forces. 
(16) (-4-3) "Neglect" means the failure to pro- 
vide care or services necessary to maintain 
the mental health or physical health and 
well-being of the client. 
17) f4-&) "Neuroleptic medication" means a 
the category of psychotropic drugs which 
is used to treat schizophrenia and related 
disorders Neuroleptics a*e the only oato 

1 1 1 \ i*\ ,' . •> i t-. ■ i-.»liAt f.-t «~> i .-» ,ln iii.- irit h 
CTTTT TTT rrTTtTTTTTTTTTTT^ (J I BTTO f f 1111 

s*4© effects ef major consequence 
tardive dyskinesia), which result in 
tardive dvskinesia. 



neuroleptic 

Chlorpromazine, 

Haloperidol. 



Examples of 
medications are 

Thioridazine and 



(18) (44} "Normalization" means the utiliza- 
tion of culturally valued moans resources 
to establish or maintain personal behav- 
iors, experiences and characteristics that 
are culturally normative or valued. 

( 19) "Physical restraint" means the limitation 
of one s freedom of movement and in- 
cludes the following: 



(A) mechanical intervention which means 
restraint of a client with the intent of 
controlling behavior with mechanical de- 
vices which include, but are not limited to, 
:uffs, ankle straps, sheets or restraining 



shirts 



(B) physical intervention which means re- 
straint of a client bv phvsicallv holding or 
subduing the client until calm. As used 
in these Rules, the term physical inter- 
vention does not apply to the use of pro- 
tessionallv recognized methods for 
therapeutic holds of brief duration (five 
minutes or less); and 

(C) protective device which means an 
intervention that provides support for 
medically fragile clients or enhances the 
safety of self-injurious clients. Such de- 
vices may include gen-chairs or table top 
chairs to provide support and safety for 
clients with major physical handicaps: de- 
vices such as seizure helmets or helmets 
and mittens for self-injurious behaviors; 



or soft ties used to prevent medically ill 
clients trom removing intravenous tubes, 
indwelling catheters, cardiac monitor 
electrodes, or similar medical devices. 
Protective device is not mechanical inter- 
vention as defined in Subparagraph 
( 19)(A) of this Rule. 



(20) "Privileged" means authorization by the 
governing body for a professional to pro- 
vide specific treatment or habilitation ser- 
vices to clients, within well defined limits, 
based on the professional's education, 
training, experience, competence and 
judgment. 

(31) "Protectiv e devic e " means a» inter 
vontion which provides support fof mod 
ically fragile clients ef enhances the safety 
e4> self injurious clients. Such devices may 
include geri chairs m- table top chairs te- 
provide support a«4 safety fo* clients with 
major physical handicaps; devices such as 
seizure helmets {*? helmets an4 mittens fop 
self injurious behaviors; e* &eft tie* used 
te- prevent medically ili clients from i=e- 
moving intravenous tubes, indwelling 
catheters, cardiac monitor e l e ctrodes, e* 
similar medical devices. Protective de- 
vices do set include mechanical restraints 
as defin e d » Subparagraph (2.1 )( A) ef this 

R-ttler 

(21 ) (33) "Responsible professional" shall have 
the meaning specified in G.S. 122C-3 ex- 
cept the "responsible professional" shall 
also be a qualified professional as defined 
in G.S. 122C-3(31). 

£33) "Restraint" means the limitation of on e 's 
freedom ef movement *h4 includes the 
following: 
(A) mechanical restraint which means pe- 
straint ef a client with the intent el con 
trolling behavior with mechanical devices 
which include. b«t a*e »et limited ter 
cuffs, anlde straps, sheets ef restraining 
shirts. 



f©4 physical restraint which means restraint 
ef a client bv physically holding e* sub 
duing the client until calm. As used » 
these Rules, the term physical restraint 
docs »et apply te the ase ef professionally 
recognized methods fef therapeutic holds 
ef brief duration (five minutes ef less). 

(22) (-3-14 "Seclusion" means isolating a client 
in a separate locked room for the purpose 
of controlling a client's behavior. 

(23) £35) "Strike" means, but is not limited to, 
hitting, kicking, slapping or beating 
whether done with a part of one's body 
or with an object. 

f2£4 "Time-out" means the removal of a 
client from positive reinforcement a«4 or 
other clients, to another space within the 
same activity area for the purpose of 
modifying behavior. 

£3?) "Treatment" means the process of 
providing for the physical, emotional. 



(24 



407 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



psychological and social needs of clients 
through services. 

f3S} "Treatment &f program plan" moans 
a» individual geai plan (fet mentally f©- 
tarded clients) e* individual treatm e nt 

t-. I - l n I l.ir m .intol ^^Aiiltli I \ V - I 1 I ~t - 1 I 1 1 i i *l 'I } 1 I I \ i \ 
I I IUI I ^IUI 1 1 1 U 1 1 L Lll 111- 1 LU III L*l ._' U U J I HI twv Ul'U ^'U 

clients), as defined m 44 NCAC 4444 
44^44 el division publication APSM 40^ 
5t4-W (LICENSURE RULES FOR- 
ME NTAL HEALTH, MENTAL R&- 
TARDATION AN© OTHER BEVEL 
OPMENTAL DISABILITIES AN© 
SUBSTANCE ABUSE FACILITIES) 
adopted pursuant to- GtSt 15QB M(o). 
"Treatment hahilitation plan" means the 
term as defined in 10 NCAC 14K .0315. 

(27) £39} "Treatment or habilitation team" 
means an interdisciplinary group of quali- 
fied professionals sufficient in number and 
variety by discipline to adequately assess 
and address the identified needs of a client 
and which is responsible for the formu- 
lation, implementation and periodic re- 
view of the client's treatment or program 
plan. 

(28) "Voluntary client" means an individual 
who is admitted to a facility upon his own 
application or that of the legally responsi- 
ble person. 

Statutory Authority G.S. 122C-3; 122C-4; 
122C-51; l22C-53(f); 122C-60; 131E-67; 
143B-147. 

SUBCHAPTER 14Q - GENERAL RIGHTS 

SECTION .0100 - GENERAL POLICIES AND 
PROCEDLRES 

.0101 POLICY ON RIGHTS RESTRICTIONS 
AND INTERVENTIONS 

(a) For each service provided in a facility where 
rights will not be restricted and interventions as 
specified in Section .0100 of Subchapter 14R of 
these Rules will not be employed, the governing 
body shall implement policies to ensure that such 
rights will not be restricted nor such interventions 
employed. 

(b) For each service provided in a facility where 
rights may be restricted, or interventions as 
specified in Section .0100 of Subchapter 14R of 
these Rules may be employed, the governing 
body shall develop and implement policies 
which: 

(1) identify the rights specified in G.S. 
122C-62(b) and (d) that may be restricted, 
as provided in G.S. 122C-62 (e) and (h), 
and interventions specified in Rule .0103, 
Rule .0104 and Rule .0106 of Subchapter 



14R that may be employed in each of its 
services; 

(2) designate an individual responsible for in- 
forming the client; 

(3) specify procedures for the following: 

(A) informing each client at the time of 
admission or entry into the service, or as 

mnn n B mni-iLLi Li i i t n , -\ L i t^ i »,->«- thin \17lfl"11Tl 

\JU\J II UJ I DOT) C7TC] T7XTC rTTT 1U 1 1 EC 1 1 1 1U11 Will I I I I 

72 hours thereafter, of rights, potential re- 
strictions and use of interventions; 

(B) assuring that a written summary of 
rights afe is provided to the client, and 
when applicable, the legally responsible 
person; and that materials are explained 
in a manner or at a level consistent with 
the client's capacity for comprehension; 

(C) educating informing the client and the 
legally responsible person regarding the 
purposes, goals and reinforcement struc- 
ture of any behavior management system 
that is allowed by governing body policy 
to restrict client rights or utilize inter- 
ventions as specified in Subparagraph 
(b)(1) of this Rule; and 

(D) documentation in the client record that 
rights have been explained including mode 
of communication used. 

Statutory Authority G.S. 122C-51; 143B-147. 

.0102 SUSPENSION AND EXPLLSION POLICY 

(a) Clients shall be free from threat or fear of 
unwarranted suspension or expulsion from ser- 
vices. 

(b) The governing body shall develop and im- 
plement policies assuring due process policy that 
assures fair procedures for suspending or expel- 
ling clients from services. Policies shall address 
the criteria to be used for any suspension, expul- 
sion or other discharge not mutually agreed upon 
and establish documentation requirements which 
shall include: 

(1) the specific time and conditions for re- 
suming services following a suspension; 
■ (2) designation of a» any alternative service 
determined to meet the client's needs; the 
facility shall exert its best effort to identify 
an alternative service; and 

(3) discharge plan. 

Statutory Authority G.S. 122C-5I: 143B-147. 

.0103 SEARCH AND SEIZURE POLICY 

(a) Clients shall be free from unwarranted in- 
vasion of privacy. The governing body shall es- 
tablish a policy develop and implement policies 
regarding the need to search clients or private 
living areas. 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



408 



PROPOSED RULES 



(b) This policy shall specify whether searches 
of clients or private living areas are allowed or 
whether they are prohibited. If searches are al- 
lowed, the policy shall address the following: 

( 1) scope of search; 

(2) reason for search; 

(3) search procedures; and 

(4) disposition of seized property. 

Statutory Authority G.S. 122C-51; 143B-147. 

.0104 ANNUAL INTERNAL AUDIT 

Each governing body shall assure the conduct 
of an annual internal compliance audit in each 
of its facilities ef regarding the implementation 
of client rights as- specified m 6^ 122C, Article 
£ an4 these rules. A written report of such 
findings shall be maintained by the governing 
body for a period of two years. 

Statutory Authority G.S. 122C-51; 143B-147. 

SECTION .0200 - INFORMING CLIENTS AND 
STAFF OF RIGHTS 

.0201 INFORMING CLIENTS OF RIGHTS 
AND RESTRICTIONS 

(a) A written summary of client rights as spec- 
ified in G.S. 122C, .Article 3 shall be made avail- 
able to all clients and legally responsible persons. 

(b) Policies specified in Rule .0101(b) of this 
Subchapter shall assure that all clients and legally 
responsible persons are informed: 

( 1 ) of the client's rights; potential restrictions 
t*f H*e e£ interventions; 

(2) of potential restrictions or use of planned 
interventions bv the facilities defined in 
14Q JUOKb); 

(3) Q+ that the legally responsible person of a 

minor or incompetent adult client may 
request notification after any occurrence 
of the use of an intervention procedure as 
specified in Subchapter 14R, Section 
.0100 of these Rules; 

(4) Q$ that the competent adult client may 
designate an individual to receive notifi- 
cation, in accordance with G.S. 
122C- 53(a), after any occurrence of the 
use of an intervention procedure as speci- 
fied in Subchapter 14R, Section .0100 of 
these Rules; 

(5) (4} of notification provisions regarding 
emergency and intervention procedures, 
as delineated in Subchapter 14R, Section 
.0100 of these Rules; and 

(6) f§} of notification provisions regarding the 

restriction of client rights as specified in 
G.S. l22C-62(e). 



Statutory Authority G.S. I22C-51; I43B-I47. 

.0202 INFORMING CLIENTS OF FACILITY 
POLICIES 

(a) Each client shall be informed of facility 
policies concerning client rights at the time of 
admission or entry into the service, or as soon 
as feasible, but no longer than 72 hours there- 
after. Documentation in the client record shall 
reflect that the client or legally responsible person 
has been informed of facility policies. 

(b) Procedures shall be implemented to assure 
that each client and legally responsible person 
shall be informed of the following: 

( 1 ) the procedure for obtaining a copy of the 
client's treatment or program plan and 
discharge plan; 

(2) any rules that the client is expected to 
follow and possible penalties for vio- 
lations; 

(3) the governing body grievance procedures 
including the individual to contact and 
procedures for assisting clients as needed; 

(4) the governing body policy regarding sus- 
pension and expulsion; 

(5) the governing body policy regarding fee 
assessment and collection practices for 
treatment or habilitation services; 

(6) the client's protections regarding disclosure 
of confidential information, as delineated 
in G.S. 122C-52 through G.S. 122C-56; 
and 

(7) the policy on search and seizure. 

Statutory Authority G.S. 122C-5I through 
I22C-56; 122C-62; 143B-147. 

.0203 INFORMING CLIENTS OF ADVOCACY 
SERVICES 

Procedures shall b*» implemented The governing 
body shall develop and implement policies to 
assure that: 

( 1 ) even" client is informed of his right to con- 
tact the Governor's Advocacy Council for 
Persons with Disabilities (GACPD), the 
statewide agency designated under federal 
and state law to protect and advocate the 
rights of persons with disabilities; 

(2) there is compliance with applicable pro- 
visions of the federal law governing advo- 
cacy services to the mentally ill. as specified 
in the Protection and Advocacy for Mentally 
111 Individuals Act of 1986 (Public Law 
99-319) and amended bv Public Law 
100-509 (1988); and 

(3) there is compliance with applicable pro- 
visions of the federal laws governing advo- 
cacy services to the developmentally 



409 



6:8 NORTH CAROLINA REGISTER July 15, 1 99 1 



PROPOSED RULES 



disabled, the Developmental Disabilities 
Assistance and Bill of Rights Act, 42 U.S.C. 
§ 6000 et. seq. 

Statutory Authority G.S. 122C-53; 143B-147; 
143B-403.1; 143B-403.2. 

.0204 INFORMING STAFF OF POLICIES 

The governing body shall develop and imple- 
ment policies to assure that all staff shall be are 
informed at the time of employment and annu- 
ally thereafter, of the rights of clients as specified 
in 122C, Article 3, and- be familiar with policioo 
specified tft this manual, all applicable rules, and 
policies of the governing body. Documentation 
of receipt of information shall be signed by the 
staff member and remain a part of the individ- 
ual's personnel record. 

Statutory Authority G.S. 122C-51; I43B-147. 

SECTION .0300 - GENERAL CIVIL, LEGAL AND 
HUMAN RIGHTS 

.0301 SOCIAL INTEGRATION 

Each client shall be encouraged to participate in 
appropriate and generally acceptable social inter- 
actions and activities with other clients and non- 
client members of the community, including 
non handicapped persons othor than staff A cli- 
ent shall not be prohibited from such social 
interactions unless restricted in writing in the cli- 
ent record in accordance with G.S. 122C-62(e). 



Statutory 
143B-I47. 



Authority G.S. 122C-51; 122C-62; 



.0302 CLIENT SELF-GOVERNANCE 

The governing body shall establish a process fef 
develop and implement policy regarding client 
input into facility governance, and encourage and 
support the development of client self- 
governance groups. 



Statutory 
143B-147. 



Authority G.S. 122C-51; I22C-5S; 



.0303 INFORMED CONSENT 

(a) Consents required in thoso Rules and- GtSt 
122C 57(f) G.S. 122C-57(f) and these Rules shall 
be obtained in writing. 

(b) Information which is necessary te- ade- 
quatoly inform the client A consent shall be 
documented in the client record and shall include 
the following: 

( 1 ) name of the procedure or treatment and 
its purpose expressed in laymen's terms; 

(2) evidence that the benefits, risks, possible 
complications and possible alternative 



methods of treatment have been explained 
to the client or legally responsible person; 

(3) notification that the consent may be 
withdrawn at any time without reprisal; 

(4) specific length of time for which consent 
is valid; 

(5) permission granted to perform the proce- 
dure or treatment; 

(6) signature of the client or legally responsi- 
ble person on written authorizations. 



Statutory A uthority 
13IE-67; 143B-147. 



G.S. I22C-51; J22C-57; 



.0304 CORPORAL PUNISHMENT 

Corporal punishment is prohibited, as specified 
in G.S. 122C-59. The «se ef corporal punish 
mont by employees is considered abuso a»4 in- 
vestigated- as ouch as specified i» Investigation of 
suspected abuse shall be in accordance with Rule 
.0306 of this Section. 

Statutory Authority G.S. 122C-59; 143B-147. 

.0305 PROTECTION FROM HARM, ABUSE, 
NEGLECT OR EXPLOITATION 

(a) Each governing body shall develop policies 
in accordance with G.S. 122C-59, G.S. 122C-65, 
and G.S. 122C-66. 

(b) Employees shall protect clients from harm, 
abuse, neglect and exploitation in accordance 
with G.S. 122C-66. 

(c) Employees shall not subject a client to any 
sort of neglect or indignity, or inflict physical or 
mental abuse upon any client including, but not 
limited to, striking, burning, cutting, teasing, 
pinching, taunting, jerking, pushing, tripping or 
baiting a client. 

(d) Employees shall not sell or buy goods or 
services to or from a client except in professional 
services delivered by the client, in public retail or 
through established governing body policy. 

(e) Employees shall use only that degree of 
force necessary to repel or secure a violent and 
aggressive client and which is permitted by gov- 
erning body policy. The degree of force that is 
necessary depends upon the individual character- 
istics of the client (such as age, size and physical 
and mental health) and the degree of 
aggressiveness displayed by the client. Use of 
intervention techniques shall be in compliance 
with Subchapter 14R of this Chapter. 

(f) Each governing body must develop moni- 
toring procedures to assure compliance with G.S. 
122C-59, G.S. 122C-65, and G.S. 122C-66. 



Statutory A uthority 
122C-66; 143B-147. 



G.S. 122C-59; I22C-65; 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



410 



PROPOSED RULES 



.0306 REPORTING ABUSE, NEGLECT OR 
EXPLOITATION 

The governing body shall develop and imple- 
ment procedures policy to assure that all in- 
stances of alleged or suspected abuse, neglect or 
exploitation of clients shall be> are reported to the 
Countv Department of Social Services as speci- 
fied in G.S. 108A, Article 6 or G.S. 7A, Article 
44. 

Authority G.S. 7A. Article 44; 108A, Article 6; 
122C-5I; 122C-59; I22C-65; 122C-66; 
143B-I47; 143B-403.1; PAMII Act, 42 U.S.C. 
10801. 

SUBCHAPTER I4R TREATMENT OR 
HABILITATION RIGHTS 

SECTION .0100 - PROTECTIONS REGARDING 
INTERVENTION PROCEDURES 

.0101 LEAST RESTRICTIVE ALTERNATIVE 

(a) The g**al erf all treatment a«4 habitation 
shall b# Facilities shall strive to provide services 
in the least restrictive, most appropriate and ef- 
fective positive treatment modalities. 

(b) Any intervention procedure designed to re- 
duce a behavior shall always be accompanied by 
positive treatment or habilitation methods. 

Statutory Authority G.S. 122C-51; 122C-53; 
131E-67; 143B-147. 

.0102 PROHIBITED PROCEDURES 

Each governing body shall develop and imple- 
ment policies regarding prohibited interventions. 
Such policies shall specify: 
(1) those interventions which have been pro- 
hibited by statute or rule which shall in- 
clude: 

(a) any intervention which would be consid- 
ered corporal punishment under G.S. 
122C-59; 

(b) the contingent use of painful body contact; 

(c) substances administered to induce painful 
bodily reactions, exclusive of Antabuse; 

(d) electric shock (excluding medically ad- 
ministered electroconvulsive therapy); 

(e) insulin shock; 

(f) unpleasant tasting foodstuffs; 

(g) planned non-attention to specific undesir- 
able behaviors when the target behavior 
is health threatening; 

(h) contingent deprivation of any basic ne- 
cessity; 

(1) contingent application of any noxious 
substances which include but arc not lim- 



ited to noise, bad smells or splashing with 
water; and 
(j) any potentially physically painful proce- 
dure or stimulus which is administered to 
the client for the purpose of reducing the 
frequency or intensity of a behavior. 
(2) those interventions determined by the gov- 
erning body to be unacceptable or prohib- 
ited for use in the facility, ef prohibited by 
the funding agencies &f regulations. 

Statutory Authority G.S. I22C-51; I22C-57; 
122C-59; 131E-67; 143B-147. 

.0103 GENERAL POLICIES REGARDING 
INTERVENTION PROCEDURES 

(a) This Rule applies only to service's facilities 
utilizing the following interventions: 

(1) exclusionary time-out for more than 15 
minutes; 

(2) time-out for more than one hour; 

(3) contingent withdrawal or delay of access 
to personal possessions or goods to which 
the client would ordinarily be entitled; 

(4) consistent deprivation of items or cessa- 
tion of an activity which the client is 
scheduled to receive (other than basic ne- 
cessities); 

(5) overcorrection to which the client resists; 
and 

(6) other interventions specified in Rule .0104 
and Rule .0106 of this Section. 

(b) The governing body shall develop policies 
and procedures for the use of interventions spec- 
ified in Paragraph (a) of this Rule, determined to 
be acceptable for use in the facility. Such policies 
shall includ e : These policies and procedures shall 
be in accordance with the provisions of Subpar- 
agraph I 1 I or I 2) o[ this Paragraph. 

( 1 ) Such policies and procedures, approved 
by the Commission, shall ensure: 

(A) timely notice and explanations to the 
client, legally responsible persons and, if 
requested, by the clients or others; 

(B) valid opportunities to consent to or re- 
fuse planned interventions; 

(C) the intervention is justified, properly 
time-limited, not applied too frequently, 
and that appropriate positive and less in- 
trusive alternatives are thoroughly, sys- 
tematically and continuously considered 
and used; 

(D) as soon as the intervention is used on 
a recurring or planned basis, the inter- 
vention will be incorporated into a treat- 
ment or habilitation plan which contains 
sufficient specifics to ensure adequate 
follow-through and accountability; 



411 



6:8 NORTH CAROLINA REGISTER July 15, 1 99 1 



PROPOSED RULES 



(E) implementation by trained staff, closely 
supervised by credentialed professional; 

(F) manner, conditions and location of the 
intervention are safe and humane; 

(G) implementation is adequately moni- 
tored and the monitoring results are 
properly disseminated to assure adequate 
follow-through, continuing justification 
and timely adjustment to meet changing 
circumstances; and 

(H) that the safeguards in this Rule are ad- 
equately documented. 
(2) Such policies and procedures shall include: 

(A) ft) procedures for ensuring that the 
competent adult client or legally responsi- 
ble person of a minor client or incompe- 
tent adult client is informed: 

(i) (A) of the general types of inter- 
ventions that are authorized for use by 
the facility; and 

(ii) (-B) that the legally responsible person 
can request notification of each use of 
an intervention as specified in this Rule, 
in addition to those situations required 
by G.S. 122C-62. When multiple 
interventions are required during a 
24-hour period, such notification may 
be summarized to the legally responsi- 
ble person one time during each 
24-hour period; 

(iii') {&} that the competent adult client 
may designate an individual to receive 
notification, in accordance with G.S. 
122C-53(a), after any occurrence of the 
use of an intervention procedure -as 
specified in Subchapter 14R, Section 
.0100 of this Chapter. 

(B) (3) provisions for humane, secure and 
safe conditions in areas used for the inter- 
vention, such as adequate ventilation, 
light and a room temperature consistent 
with the rest of the facility; 

(C) (^ appropriate attention paid to the 
need for fluid intake and the provision of 
regular meals, bathing and the use of the 
toilet. Such attention shall be docu- 
mented in the client record; and 

(D) (4) procedures for assuring that when 
an intervention as specified in this Rule 
has been used with a client three or more 
times in a calendar month, the following 
requirements are met: 

(i) (A) A treatment or program plan de- 
veloped within ten working days of the 
third intervention. The treatment or 
program plan shall include, but not be 
limited to: 
(I) fi} indication of need; 



(II) («) specific description of problem 
behavior; 

(III) (iii) specific goal to be achieved 
and estimated duration of procedure; 

(IV) (iv) specific early intervention 
when precursor behaviors are exhib- 
ited; 

(V) (^ specific procedure to be em- 
ployed; 

(VI) (¥*) specific methodology of the 
intervention; 

(VII) (¥») methods for measuring 
treatment efficacy; 

(VIII) (viii) guidelines for discontinua- 
tion of the procedure; 

(IX) (i*) the accompanying positive 
treatment or habilitation methods 
which are intended to be as strong as 
the negative aspects of the plan; and 

(X) (#} the specific limitations on ap- 
proved uses of the intervention per 
episode and per day and requirements 
for on-site assessments by the re- 
sponsible professional. 

(ii) 0) In emergency situations, a quali- 
fied professional may continue to use 
the intervention until the planned 
intervention is addressed in the treat- 
ment or program plan. 

(iii) fC) The qualified professional shall 
explain the intervention and the reason 
for the intervention to the client and the 
legally responsible person, if applicable, 
and document such explanation in the 
client record. 

(iv) (©) Before implementation of the 
planned intervention, the treatment or 
habilitation team, if there is one, shall 
approve the treatment or program plan. 

(v) f6) The use of the intervention shall 
be reviewed at least monthly by the 
treatment or habilitation team. 

(vi) f£) If a client or legally responsible 
person refuses the use of such proce- 
dures, the right to refuse treatment 
procedures as required in Rule .0302 of 
this Subchapter shall be followed. 

(vii) (4*} The interventions specified in 
this Rule shall never be the sole treat- 
ment modality designed to eliminate the 
target behavior. Interventions are to 
be used consistently and shall always 
be accompanied by positive treatment 
or habilitation methods. 
(c) If the governing body chooses to comply 
with Subparagraph (b)(2) of this Rule, the fol- 
lowing provisions shall also be applicable: 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



412 



PROPOSED RULES 



( 1 ) (6) Whenever the interventions as specified 

in this Subchapter result in the restriction 
of a right in a 24-hour facility as specified 
in G.S. 122C-62(b) and (d), procedures 
specified in G.S. 122C-62(e) shall be fol- 
lowed. Exceptions to this Rule include 
the use of seclusion, restraint and isolation 
time-out, which are regulated in Rule 
.0104 of this Section. 

(2) (4^ Facility employees who authorize and 

implement interventions shall be privi- 
leged to do so, as well as to utilize alter- 
native approaches. Such assurances shall 
be documented and maintained in the 
personnel records of facility employees. 

(3) fe} Statistical records that reflect the fre- 

quency and duration of the individual uses 
of interventions specified in this Rule shall 
be maintained. This statistical record 
shall be made available to the Human 
Rights Committee, if there is one, and the 
governing body at least quarterly. 

Statutory Authority G.S. 122C-51; 122C-53; 
122C-60; 122C-62; 131E-67; 143B-147. 

.0104 SECLUSION, RESTRAINT AND 
ISOLATION TIME OLT 

(a) This Rule delineates the procedures to be 
followed for seclusion, restraint and isolation 
time-out in addition to the procedures specified 
in Rule .0103(b) through fe4 {c]_ of this Section. 

(b) Those facilities which intend to employ the 
use of mechanical restraint or seclusion of a client 
shall be designated as a restrictive facility by the 
Division of Facility Services. 

(c) This Rule governs the use of specific phys- 
ical or behavioral interventions which are used to 
terminate a behavior or action in which a client 
is in imminent danger of abuse or injury to self 
or other persons or when substantial property 
damage is occurring, or which is used as a meas- 
ure of therapeutic treatment. Such interventions 
include: 

(1) seclusion: 

(2) restraint; and 

(3) isolation time-out. 

(d) The use of seclusion, restraint and isolation 
time-out shall be limited to those situations 
specified in G.S. 122C-60, which include: 

( 1 ) emergency interventions (planned and 
unplanned); and 

(2) therapeutic treatment as specified in Rule 
.0106 of this Section. 

(e) If det e rniinc - d to be acceptable fef i*<# within 
Ae facility. The governing body shall establish 
develop written policies and procedures that 
govern the use of seclusion, restraint and iso- 



lation time-out, which shall include th<* follow 
ifier if determined to be acceptable for use within 
the facility. These policies and procedures shall 
be in accordance with the provisions of Subpar- 
agraph Qi or [2| of this Paragraph. 

( 1) Such policies and procedures, approved 
by the Commission, shall ensure: 

(A) timely notice and explanations to the 
client, legally responsible persons and if 
requested by the clients or others; 

(B) valid opportunities to consent to or re- 
fuse planned interventions: 

(C) the intervention is justified, properly 
time-limited, not applied too frequently, 
and that appropriate positive and less in- 
trusive alternatives are thoroughly, sys- 
tematically and continuously considered 
and used: 



(D) as soon as the intervention is used on 
a recurring or planned basis, the inter- 
vention will be incorporated into a treat- 
ment or habitation plan which contams 
sufficient specifics to ensure adequate 
follow-through and accountability; 

(E) implementation by trained statf. closely 
supervised bv credentialed professional; 

(F) manner, conditions and location of the 
intervention are safe and humane; 

(G) implementation is adequately moni- 
tored and the monitoring results are 
properly disseminated to assure adequate 
follow-through, continuing justification 
and tunelv adjustment to meet changing 
circumstances: and 

(II) that the safeguards in this Rule are ad- 
equately documented. 
(2) Such policies shall include: 

(A) (4} process for identifying and privileg- 
ing facility employees who may authorize 
and implement such interventions; 

(B) f34- provisions that a qualified or re- 
sponsible professional shall: 

(i) (A) review the use of the intervention 
as soon as possible but at least within 
one hour of the initiation of its use; 

(ii) (434 verify the inadequacy of less re- 
strictive intervention techniques; and 

(iii) (€4 document in the client record ev- 
idence of approval or disapproval of 
continued use. 

(C) (-44 procedures for documenting in the 
client record the intervention which oc- 
curred, to include, but not be limited to: 
(i) (A4 the rationale for the use of the 

intervention which also addresses the 
inadequacy of less restrictive inter- 
vention techniques; 



413 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



(ii) (©) notation of the frequency, inten- 
sity and duration of the behavior and 
any precipitating circumstance contrib- 
uting to the onset of the behavior; 

(iii) {G$ description of the intervention 
and the date, time and duration of its 
use; and 

(iv) (©) signature and title of the facility 
employee responsible for the use of the 
intervention. 

(D) (4) procedures for the notification of 
others to include: 

(i) (A} those to be notified as soon as 
possible but no more than 72 hours af- 
ter the behavior has been controlled to 
include: 

(I) (+) the treatment or habitation 
team, or its designee, after each use 
of the intervention; and 

(II) («} a designee of the governing 
body. 

(ii) (-B) notification in a timely fashion of 
the legally responsible person of a mi- 
nor client or an incompetent adult cli- 
ent when such notification has been 
requested. 

(E) (4) procedures to identify clients with 
reasonably foreseeable physical conse- 
quences to the use of restraint, shall in- 
clude, but not be limited to: 

(i) (A) documentation of clients with 
physical disability or past surgical pro- 
cedures that would make affected nerves 
and bones sensitive to injury; and 
(ii) fJ&) the identification and documenta- 
tion of alternative emergency proce- 
dures if needed. 
(f) If the governing body does not choose to 
comply with Subparagraph (e)(2) of this Rule, 
the following provisions shall be applicable: 
( 1) (£)• Any room used for seclusion or iso- 
lation time-out shall meet the following 
criteria: 

(A) (-14 The room shall be designed and 
constructed to ensure the health, safety 
and well-being of the client. 

(B) (r34 The floor space shall not be less than 
50 square feet, with a ceiling height of not 
less than eight feet. 

(C) (4) Floor and wall coverings, as well as 
any contents of the room, shall have a 
one-hour tire rating and shall not produce 
toxic fumes if burned. 

(D) £4} The walls shall be kept completely 
free of objects. 

(E) (44 A lighting fixture, equipped with a 
minimum of a 75 watt bulb, shall be 



mounted in the ceiling and be screened to 
prevent tampering by the client. 

(F) (4) One door of the room shall be 
equipped with a window mounted in a 
manner which allows inspection of the 
entire room. Glass in any windows shall 
be impact resistant and shatterproof. 

(G) £4) The room temperature and venti- 
lation shall be comparable and compatible 
with the rest of the facility. 

(H) (8} In a room where the door is not 
under direct observation by staff and if a 
staff person is not assigned to contin- 
uously observe the area during the dura- 
tion of the confinement, the lock on the 
room shall be interlocked with the fire 
alarm system so that the door automat- 
ically unlocks when the fire alarm is acti- 
vated. 

(2) fg) Seclusion, restraint and isolation time- 
out shall not be employed as retaliation 
or for the convenience of staff or used in 
a manner that causes harm or undue 
physical or mental discomfort or pain to 
the client. 

(3) (44 Whenever seclusion, restraint or iso- 
lation time-out is used on an emergency 
basis prior to inclusion in the treatment 
or program plan, the following procedures 
shall be followed: 

(A) (4} A facility employee privileged to ad- 
minister emergency interventions may 
employ such procedures for up to 15 
minutes without further authorization. 

(B) (4^ A qualified professional who has ex- 
perience and training in the use of seclu- 
sion, restraint or isolation time-out and 
who has been privileged to employee such 
interventions, may authorize the contin- 
ued use of such interventions for up to 
one hour from the time of initial employ- 
ment of the intervention. If a qualified 
professional is not immediately available 
to conduct an assessment of the client, but 
after discussion with the facility employee, 
concurs that the intervention is justified 
for longer than 15 minutes, continuation 
of the intervention may be verbally au- 
thorized for up to one hour. The quali- 
fied professional shall observe and assess 
the client within one hour after authoriz- 
ing the continued use of the intervention. 
If the intervention needs to be continued 
for longer than one hour, the professional 
responsible for the client's treatment or 
program plan shall be consulted. 

(C) (4) Use of isolation time-out shall not 
exceed one hour in Intermediate Care 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



414 



PROPOSED RULES 



Facilities for the Mentally Retarded 
(ICF MR). 
(D) rM The continued use of seclusion or 
restraint for over one hour shall only be 
authorized by the responsible profes- 
sional. If the responsible professional is 
not immediately available to conduct a 
clinical assessment of the client, but after 
discussion with the qualified professional, 
concurs that the seclusion or restraint is 
justified for longer than one hour, contin- 
uation of the intervention may be verbally 
authorized until an on-site assessment of 
the client can be made. The responsible 
professional shall meet with and conduct 
an assessment of the client and write such 
authorization within 12 hours from the 
time of initial employment of the inter- 
vention. 

(4) (++ Whenever a client is in seclusion, re- 
straint or isolation time-out for more than 
24 continuous hours, the client's nehts, 
as specified m G.S. 122C-62(b) and (d), 
are restricted. The documentation re- 
quirements in this Rule shall satisfy the 
requirements specified in G.S. 122C-62(e) 
for restriction of rights in G.S. 122C-62(b) 
and (d). Rights specified in G.S. 
122C-62(a) and (b) shall be exercised at 
reasonable intervals. 

(5) (j4 Whenever seclusion, restraint, or iso- 
lation time-out is used more than three 
times in 30 consecutive days, the proce- 
dure shall be addressed as a planned 
intervention in the treatment or program 
plan. 

(6) (4r+ In addition to the requirements in this 
Rule, additional safeguards as specified in 
Rule .0106 of this Section shall be initi- 
ated under the following conditions: 

(A) (-4-f whenever a client exceeds spending 
40 hours, or more than one episode of 24 
or more continuous hours in emergency 
seclusion, restraint or isolation time-out 
during 30 consecutive days; or 

(B) f-3* whenever seclusion, restraint or iso- 
lation time-out is used as a measure of 
therapeutic treatment as specified in G.S. 
122C-60 and is limited to specific planned 
behavioral interventions designed for the 
extinction of dangerous, aggressi%'e or un- 
desirable behaviors. 

(7) (4} The written approval of the designee 
of the governing body shall be required 
when seclusion, restraint or isolation 
time-out is utilized for longer than 24 
continuous hours. 



(8) f«*f Standing orders or PRN orders shall 
not be used to authorize the use of seclu- 
sion, restraint or isolation time-out. 

(9) f«4 The client shall be removed from se- 
clusion, restraint or isolation time-out as 
soon as therapeutically appropriate but in 
no case shall the client remain in seclu- 
sion, restraint or isolation time-out longer 
than 30 minutes after gaining behavioral 
control. If the client is unable to gain 
self-control within the time frame speci- 
fied in the authorization, a new authori- 
zation must be obtained. 

(10) f&^ While the client is in seclusion, re- 
straint or isolation time-out, the following 
precautions shall be followed: 

(A) (44 Whenever a client is in seclusion or 
restraint, periodic observation of the client 
shall occur at least every 15 minutes, or 
more often as necessary, to assure the 
safety of the client. Appropriate attention 
shall be paid to the provision of regular 
meals, bathing, and the use of the toilet. 
Such observation and attention shall be 
documented in the client record. 

( B) (-3^ Whenever a client is in isolation 
time-out, there shall be a facility employee 
in attendance with no other immediate 
responsibility than to monitor the client 
who is placed in isolation time-out. 
There shall be continuous observation 
and verbal interaction with the client 
when appropriate. Such observation shall 
be documented in the client record. 

(C) (4} When restraint is used in the absence 
of seclusion and the client may be subject 
to injury, a facility employee shall remain 
present with the client continuously. 

(11) fp-^ Reviews and reports on the use of se- 
clusion, restraint and isolation time-out 
shall be conducted as follows: 

(A) f44 all uses of seclusion, restraint and 
isolation time-out shall be reviewed in a 
timely fashion by a designee of the gov- 
erning body and unusual or possibly un- 
warranted patterns of utilization shall be 
investigated; 

(B) (-3-^ a log which includes the following 
information on each use of restraint, se- 
clusion and isolation time-out shall be 
maintained: 

(jl {-A*} name of the client; 
(ii) (-Hi name of the responsible profes- 
sional; 
(iii) (4^ date of each intervention; 
liv) fT4+ time of each intervention: 
(v) (4^4 type of intervention; 
(vi) fP} duration of each intervention; and 



415 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



(vii) {G} reason for use of the inter- 
vention. 
(12) (q) Nothing in this Rule shall be inter- 
preted to prohibit the use of voluntary 
seclusion, restraint or isolation time-out 
at the client's request; however, the pro- 
cedures in this Rule shall apply with the 
exception of Subparagraphs (o)(3)(A) aft4 
(-&} aj*4 Paragraph fh} Subparagraphs 
(e)(2)(B)(i) and (ii), and Subparagraph 
(f)(3) of this Rule. 

Statutory Authority G.S. 122C-51; 122C-53; 
122C-60; 122C-62; 131E-67; I43B-147. 

.0105 PROTECTIVE DEVICES 

(a) Whenever protective devices are utilized for 
clients, the governing body shall develop policies 
to ensure that: 

(1) the necessity for the protective device has 
been assessed and the device applied by a 
prof e ssional person who has been trained 
and privileged in the utilization of protec- 
tive devices; 

(2) the protective device is the least restrictive 
appropriate measure; 

(3) the client is frequently observed and pro- 
vided opportunities for toileting, exercise, 
etc. as needed. Protective devices which 
limit the client's freedom of movement 
shall be observed at least every hour. 
Whenever the client is restrained and 
subject to injury by another client, a fa- 
cility employee shall remain present with 
the client continuously. Observations and 
interventions shall be documented in the 
client record; 

(4) protective devices are cleaned at regular 
intervals; and 

(5) the utilization of protective devices in the 
treatment or program plan shall be subject 
to review by the Human Rights Commit- 
tee, if there is one. 

(b) In addition to the requirements specified in 
Paragraph (a) of this Rule, protective devices 
used for behavioral control which have the effect 
of significantly restraining the client's freedom of 
movement shall comply with the requirements 
specified in Rule .0103 and Rule .0104 of this 
Section. 

Statutory Authority G.S. 122C-51; I22C-53; 
122C-60; 131E-67; 143B-147. 

.0106 INTERVENTIONS REQUIRING 
ADDITIONAL SAFEGUARDS 

(a) This Rule applies only to services utilizing 
interventions specified in Paragraph (b) of this 



Rule which present a significant risk to the client 
and, therefore, require additional safeguards. 
These procedures shall be followed in addition to 
the procedures specified in Rule .0103 and Rule 
.0104 of this Section if seclusion, restraint or iso- 
lation time-out is utilized. 

(b) The following interventions are designed for 
the primary purpose of reducing the incidence of 
aggressive, dangerous or self injurious behavior 
to a level which will allow the use of less intrusive 
treatment or habilitation procedures. Such 
interventions include the use of: 

(1) seclusion, restraint or isolation time-out 
employed as a measure of therapeutic 
treatment; and 

(2) seclusion, restraint, isolation time-out used 
on an emergency basis more than 40 
hours in a calendar month or more than 
one episode of 24 hours. 

(c) The governing body shall develop policies 
and procedures regarding additional safeguards if 
seclusion, restraint or isolation time-out are de- 
termined to be acceptable for use in the facility. 
These policies and procedures shall be in ac- 
cordance with the provisions of Subparagraph ( 1) 
or (2) of this Paragraph. 

( 1) such policies and procedures, which shall 
be approved by the Commission, shall 
ensure: 

(A) timely notice and explanations to the 
client, legally responsible persons and if 
requested by the clients or others; 

(B) valid opportunities to consent to or re- 
fuse planned interventions; 

(C) the intervention is justified, properly 
time-limited, not applied too frequently, 
and that appropriate positive and less in- 
trusive alternatives are thoroughly, sys 



tematically and continuously considered 
and used; 

(D) as soon as the intervention is used on 
a recurring or planned basis, the inter- 
vention will be incorporated into a treat- 
ment or habilitation plan which contains 
sufficient specifics to ensure adequate 
follow-through and accountability; 

(E) implementation by trained staff, closely 
supervised by credentialed professional; 

(F) manner, conditions and location of the 
intervention are safe and humane; 



(G) implementation is adequately moni- 
tored and the monitoring results are 



properly disseminated to assure adequate 
follow-through, continuing justification 
and timely adjustment to meet changing 
circumstances; and 
(H) that the safeguards in this Rule are ad- 
equately documented. 



6:8 NORTH CAROLINA REGISTER July 15, 1 99 1 



416 



PROPOSED RULES 



(2) If the governing body chooses not to de- 
velop policies and procedures as stated in 
Subparagraph (c)( 1) of this Rule the fol- 
lowing provisions shall apply: 

(A) fe4 Such interventions shall never be the 
sole treatment modality for the elimi- 
nation of target behavior. The inter- 
vention shall always be accompanied by 
positive treatment or habilitation methods 
which include the deliberate teaching and 
reinforcement of behaviors which are 
non-injurious; the improvement of condi- 
tions associated with non-injurious be- 
haviors such as an enriched educational 
and social environment; and the alteration 
or elimination of environmental condi- 
tions which are reliably correlated with 
self-injury. 

(B) (44 Prior to the implementation of any 
planned use of the interventions specified 
in Paragraph (b) of this Rule, the follow- 
ing written approvals and notifications 
shall be obtained and documented in the 
client record: 

rij (44 The responsible professional and 
the treatment or habilitation team if. 
there is one shall approve the plan. 

(ii) (44 Each client whose treatment or 
program plan includes interventions 
with reasonably foreseeable physical 
consequences shall receive an initial 
medical examination and periodic 
planned monitoring by a physician. 

(iii) (4-f The governing body shall assure 
that a client advocate has been identi- 
fied and informed that the intervention 
has been planned for the client and the 
rationale for utilization of the inter- 
vention. 

(iv) (44 The governing body shall assure 
that an Intervention Advisory Com- 
mittee as defined in Rule .0107 of this 
Section has been organized and in- 
formed regarding the intervention being 
planned for the client. Confidential in- 
formation provided to the advisory 
committee shall be within the con- 
straints of G.S. 122C-53(a). 

(v) (44 A designee of the treatment or ha- 
bilitation team shall explain the inter- 
vention and the reason for the 
intervention to the client and the legally 
responsible person, if applicable. The 
prior written consent of the client or 
legally responsible person shall be ob- 
tained except for those situations speci- 
fied in ft*4e .0101(10(1) Rule 
.0104(f)(6)(A) of this Section. If the 



client or legally responsible person, if 
applicable, refuses the intervention, the 
governing body's procedures regarding 
the right to refuse treatment procedures 
shall be followed. 

(C) f«4 If any of the persons or committees 
specified in Subparagraphs (d)(1), (44? f+h 
Bf ^ Subparagraphs (c)(2)(B)(i), (ii), 
(ui), (iv) or (_v| of thus Rule do not ap- 
prove the continued use of a planned 
intervention, the planned intervention 
shall be terminated. The governing body 
shall establish an appeal mechanism for 
the resolution of any disagreement over 
the use of the intervention. 

(D) (44 Neither the consents nor the ap- 
provals specified in Paragraph (44 Sub- 
paragraph (c)(2)(B) of this Rule shall be 
considered valid for more than six 
months. The responsible professional and 
the treatment or habilitation team, if there 
is one, shall re-evaluate the use of the 
intervention and obtain the client's and 
legally responsible person's consent for 
continued use of the intervention. The 
decision to continue the intervention shall 
be based on clear and recent behavioral 
evidence that the intervention is having a 
positive impact and continues to be 
needed. 

(E) fg4 The plan shall be reviewed at the 
next meeting of the Intervention Advisory 
Committee within the constraints of 10 
NCAC 18D .0215, division publication 
APSM 45-1, 1 10/86, 
(CONFIDENTIALITY RULES), 
adopted pursuant to G.S. 1 SOB- 14(c). 
The Committee, by majority vote, may 
recommend approval or disapproval of 
the plan or may abstain from making a 
recommendation. Implementation of the 
intervention shall be reviewed by the 
Committee within 30 days of the initiation 
of the plan. 

(F) (4*4 The intervention shall be used only 
when the responsible professional and the 
treatment or habilitation team, if there is 
one. has determined and documented in 
the client record the following: 

rij (44 that the client is engaging in be- 
haviors that are dangerous, aggressive 
and likely to result in injury to self or 
others; 

(ii) (44 that other methc>ds of treatment 
or habilitation employing less intrusive 
interventions are not appropriate or ef- 
fective, with the reasons supporting this 
determination; 



417 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



(iii) £4) the frequency, intensity and dura- 
tion of the target behavior, and the be- 
havior's probable antecedents and 
consequences; and 
(iv) (4) that in the case of aversive inter- 
ventions, a systematic study on alterna- 
tives to such interventions has been 
conducted and other non-aversive tech- 
niques have been tried and did not 
work; 
(G) (i) Accurate and up-to-date written re- 
cords shall be maintained on the applica- 
tion of the intervention and 
accompanying positive procedures. These 
records shall include at a minimum the 
following: 

(i) (4} data which reflect the frequency, 
intensity and duration with which the 
targeted behavior occurs (scientific 
sampling procedures are acceptable); 
(ii) (4) data which reflect the frequency, 
intensity and duration of the inter- 
vention and any accompanying positive 
procedures; and 
(iii) (4} data which reflect the facility em- 
ployees who administered the inter- 
ventions. 
(H) ff) The governing body shall assure that 
the interventions are evaluated at least 
weekly and are documented in the client 
record. A qualified professional shall be 
involved in this evaluation at least every 
other week. 
(I) fk4 During the use of the intervention, 
the intervention advisory committee shall 
be given the opportunity to review the 
treatment or program plan within the 
constraints of 10 NCAC 18D .0215 divi- 
sion publication APSM 45-1, 1/10/86, 
(CONFIDENTIALITY RULES) 

adopted pursuant to G.S. 150B- 14(c). 

Statutory Authority G.S. 122C-5I; 122C-53; 
122C-57; 122C-60; 122C-62; I31E-67; 143B-147. 

.0107 INTERVENTION ADVISORY 
COMMITTEES 

(a) Intervention advisory committees shall be 
established to provide an additional safeguard in 
those facilities that utilize intrusive treatment or 
habilitation interventions specified in Rule 14R 
.0106. For facilities operated by or under con- 
tract with an area program, the Intervention Ad- 
visory Committee shall be appointed by the 
Client Rights Committee. For facilities operated 
by or under contract with an area program the 
Intervention Advisory Committee shall be the 



Client Rights Committee or a subcommittee of 
it^ which may include other members. 

(b) The Committee shall h% composed »f in- 
clude at least three te five concerned citizens who 
are not employees of, or members of, the gov- 
erning body. One &f th» individual shall b» The 
Intervention Advisory Committee shall have a 
member or a regular independent consultant who 
is a professional with training and expertise in the 
use of the type of interventions being utilized, 
who is not involved in the treatment or habili- 
tation of the client. The Committee shall also 
include at least one person who is or has been a 
consumer or who is a close relative of a con- 
sumer. 

(c) Each committee shall have policies govern- 
ing its operation. 

(d) The governing body shall assure that the 
committee is supplied with appropriate statutes 
and rules governing client rights and related is- 
sues and literature about the proposed inter- 
ventions and their alternatives. The governing 
body shall also assure that each member of the 
Committee has received specific training and ori- 
entation as to the charge of the Committee. 

(e) The Committee shall maintain minutes of 
each meeting. Care shall be taken that the min- 
utes do not violate the provisions of G.S. 
122C-52. 

(f) Each committee shall make an annual writ- 
ten report to the governing body on the activities 
of the Committee. 

(g) Committee members shall have access to 
client records on a need to know basis only upon 
the written informed consent of the client or his 
legally responsible person as specified in G.S. 
122C-53(a). This access shall be given only 
when necessary for committee members to per- 
form their duties. 

(h) Committee members shall treat the client 
record as confidential information in accordance 
with G.S. 122C-52 through G.S. 122C-56. 

(i) Each committee shall have a caseload of not 
more than 30 clients whose intrusive inter- 
ventions are being reviewed. 

(f} A- I Iuman Righto Committoo serving this 
function shall comply w4h this Rul e . 



Statutory A uthority 
122C-56; I43B-147. 



G.S. 122C-5I through 



SECTION .0200 - PROTECTIONS REGARDING 
MEDICATIONS 

.0201 SAFEGUARDS REGARDING 
MEDICATIONS 

(a) The facility shall follow the Rules in 10 
NCAC 14K .0349 through .0355, G.S. 122C-57, 



6:8 NORTH CAROLINA REGISTER July 15, 1 991 



418 



PROPOSED RULES 



and G.S. 90, Articles 1, 4A and 9A when utilizing 
drugs or medication. 

(b) The use of experimental drugs or 
medication shall be considered research and shall 
be governed by 4Q NCAC 444v mU a*d mM 
and- K) NCAC 14K .0333, .0334, G.S. 122C-57(0 
and applicable federal law. 

(c) The governing body of a medical service 
which utilizes neuroleptic medications shall es- 
tablish the following policies and procedures rel- 
ative to utilization of such medications and 
safeguards for prevention of tardive dyskinesia in 
accordance with sound medical practice: 

( 1 ) methods fof minimizing the risk of tardive 

dyskinesia by prescribing neuroleptic 
medication judiciously and in the lowest 
possible therapeutic dosages. 

(2) training aimed at education of facility staff 
regarding indications for using neuroleptic 
medication, expected therapeutic effects 
of neuroleptic medication and common 
side effects including indications of tardive 
dyskinesia; and 

(3) procedures fof monitoring clients on 
neuroleptic medications for signs of 
tardive dyskinesia including the following: 

(A) designation of a standardized procedure 
or rating system; 

(B) frequency of client examinations; 

(C) training and privileging of examiners in 
the selected methodology; and 

(D) documentation in the client record. 



Statutory Authority G.S. 
131E-67; I43B-147. 



122C-51; 122C-57; 



SECTION .0300 - RIGHT TO REFUSE 
TREATMENT 

.0301 THERAPEUTIC AND DIAGNOSTIC 
PROCEDURES 

In addition to the treatment procedures speci- 
fied in G.S. 122C-57(a) through (f), other intru- 
sive procedures which are not routine medical 
diagnostic or treatment procedures shall require 
the express aftd informed written consent of the 
client or legally responsible person in accordance 
with 14Q .0303, prior to their initiation except in 
medical emergencies. Procedures requiring writ- 
ten consent shall include, but are not limited to, 
the prescription or administration of the follow- 
ing drugs: 

(1) Antabuse; and 

(2) Depo-Provera when used for non-FDA 
approved uses. 

Statutory Authority G.S. 90-21.1; 90-21.13; 
122C-5I; 122C-57; 131E-67; I43B-147. 



.0302 INTRUSIVE INTERVENTIONS 

(a) Interventions as specified in Rules .0103 
through .0106 of this Subchapter shall not be 
administered to a voluntary client in a non- 
emergency situation if the client or legally re- 
sponsible person refuses the interventions except 
for those situations specified in 44ft- ,0l0'1(k)(l). 
14R .0104(f)(6)(A). 

(b) The governing body shall develop and im- 
plement policies assuring due process procedures 
for involuntary clients who refuse the use of in- 
trusive interventions. 



Statutory Authority G.S. 
131E-67; I43B-147. 



122C-51; 122C-57; 



.0303 REFUSAL OF CONSENT 

A voluntary client's refusal of consent shall not 
be used as sole grounds for termination or threat 
of termination of services unless such procedures 
are the only viable treatment option available. 



Statutory Authority 
1 43 B- 147. 



G.S. J22C-51; 122C-57; 



SUBCHAPTER 14S - 24-HOUR FACILITIES 

SECTION .0100 - SPECIFIC RULES FOR 
24-HOUR FACILITIES 

.0101 SCOPE 

Clients of mental health, developmental disa- 
bilities and substance abuse services are provided 
certain rights through the General Statutes. This 
Subchapter delineates those rights that are rele- 
vant to residential and inpatient servic e s. 
24-hour facilities. 



Statutory Authority 
1 43 B- 147. 



G.S. 122C-5I; I22C-62; 



.0102 COMMUNICATION RIGHTS 

(a) Except as provided in G.S. 122C-62(e), cli- 
ents in a 24-hour facilities facility maintain com- 
munication rights as specified in 122C-62. at- ail 
reasonable times. 

(b) In order to ensure the protection of client 
rights specified in G.S. 122C-62(a)(l) and G.S. 
122C-62(d)(2), each facility shall make limited 
postage available to indigent clients. 

(c) Upon request, adult clients shall have access 
to telephones in private areas when requested by- 
the client, in order to ensure the protection of the 
client right specified in G.S. 122C-62(b)(l). Ac- 
cess shall also be in accordance with Section 504 
of the Rehabilitation Act of 1973 and 1978. 

Statutory Authority G.S. 122C-62; 143B-147. 



419 



6:S NORTH CAROLINA REGISTER July 15, 1 99 1 



PROPOSED RULES 



.0103 LIVING ENVIRONMENT 

(a) Efforts shall be made to: 

(1) provide a quiet atmosphere for uninter- 
rupted sleep during scheduled sleeping 
hours; and 

(2) provide areas accessible to the client for 
personal privacy, for at least limited peri- 
ods of time, unless determined inappro- 
priate by the treatment or habilitation 
team. 

(b) Each client may shall be free to suitably 
decorate his room, ©f his portion of a multi- 
resident room, with respect to the client's choice, 
normalization principles, and with respect for the 
physical structure. Any restriction shall be in 
accordance with written governing body policy. 
¥he governing body may establish written poli 
eies aftd justifications which limit this right » 
certain circumstanc e s such as resource limitations 
a«4 fe* special admissions (e.g., short term ad- 
missions whore admission is fof less than 34> 
aays^ 

Statutory Authority G.S. I22C-51; 122C-62; 
143B-147. 

.0104 HEALTH, HYGIENE AND GROOMING 

(a) Each client shall be assured the right to 
dignity, privacy and humane care in the provision 
of personal health, hygiene and grooming care 
including, but need not be limited to the: 

(1) opportunity for a shower or tub bath 
daily, or more often as needed; 

(2) opportunity to shave at least daily; 

(3) opportunity to obtain the services of a 
barber or a beautician; and 

(4) provision of linens and towels, toilet paper 
and soap for all clients and other individ- 
ual personal hygiene articles for indigent 
clients. Such other articles include but are 
not limited to toothpaste, toothbrush, 
sanitary napkins, tampons, shaving cream 
and shaving utensil. 

(b) Bathtubs or showers and toilets which en- 
sure individual privacy shall be available. 

(c) Adequate toilets, lavatory' and bath facilities 
equipped for use by clients with mobility 
impairments shall be available. 

Statutory Authority G.S. 122C-5I; 122C-62; 
143B-147. 

.0105 STORAGE AND PROTECTION OF 
CLOTHING AND POSSESSIONS 

The facility shall make every effort to protect 
the client's personal clothing and possessions 
from theft, damage, destruction, loss, and mis- 



placement. This includes, but is need not be 
limited to, assisting the client in developing and 
maintaining an inventory of clothing and per- 
sonal possessions if the client or legally responsi- 
ble person desires. 

Statutory Authority G.S. I22C-62; I43B-147. 

.0106 CLIENT'S PERSONAL FUNDS 

(a) This Rule applies to any 24-hour facilities 
facility which typically provide provides residen- 
tial services to individual clients for more than 
30 days. 

(b) Competent adult clients and minors above 
the age of 16 shall be assisted and encouraged to 
maintain or invest their money in personal fund 
accounts other than at the facility. This shall 
include, but need not be limited to, investment 
of funds in interest-bearing accounts. 

(c) If funds are managed for clients by the fa- 
cility, the governing body shall develop and im- 
plement, when applicable, written policies and 
procedures for internal personal fund accounts 
which: 

(1) assure to the client the right to deposit and 
withdraw money; 

(2) regulate the receipt and distribution of 
funds in personal fund accounts; 

(3) provide for the receipt of deposits in per- 
sonal fund accounts from friends, relatives 
or others and withdrawal by the client; 

(4) provide for the keeping of adequate fi- 
nancial records on all transactions affect- 
ing funds on deposit in personal fund 
accounts; 

(5) assure that the funds will be kept separate 
from any operating funds of the facility; 

(6) provide for the deduction from personal 
fund accounts for treatment or habili- 
tation services when authorized by the 
client or legally responsible person upon 
or subsequent to admission of the client; 

(7) provide for the issuance of receipts to 
persons depositing or withdrawing funds; 
and 

(8) provide the client with a quarterly ac- 
counting of personal fund accounts. 

(d) ¥ke facility may ©et- deduct from a personal 
fund account a©y- amount owed ©f alleged t© be 
owed t© the facility ©f a» employee ©f visitor t© 
the facility ©f other client ©f the facility £©f dam 

i-i i-tr^ r- r\ /-A r\ <1 t-i r- ilLi,m,-l t .-t V-i ■> i - . i L> . t. »»i . i ■ "■ r-i .-. Y~. \ - +It^ 

u ^^ . i UL'i i\j rr u 1 1\. jsw* rrr i iu f \~ I'll ii ut' r iv i_' t rrru 

client t© the facility, employ ee , visitor ©f other 
client, unless the legally responsible person au- 
thorises the deduction. Unless authorized by the 
client or legally responsible person, the facility 
shall not deduct from a personal fund account 
any amount owed or alleged to be owed, or for 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



420 



PROPOSED RULES 



damages done or alleged to have been done by 
the client: 

(1) to the facility; 

(2) an employee of the facility; 

(3) to a visitor of the facility; or 

(4) to another client of the facility. 

(e) The facility may not use the fact that a cli- 
ent or legally responsible person does not au- 
thorize a deduction as grounds for termination 
or threat of termination of services. 

Statutory Authority G.S. 122C-5I; 122C-58; 
122C-62; 143B-/47. 



CHAPTER 18 



MENTAL HEALTH: OTHER 
PROGRAMS 



SUBCHAPTER 18L - PROGRAM COMPONENT 
OPERATIONAL STANDARDS 

SECTION .0400 - CLIENT RIGHTS 

.0433 PROTECTION OF CLIENT RIGHTS 

(a) Each area program shall adopt develop and 
implement policies a»4 procedures to assure the 
protection of client rights for clients served by the 
area program a«4 ite contract agencies as speci- 
fied in CLIENT RIGHTS IN COMMUNITY 
MENTAL HEALTH, DEVELOPMENTAL 
DISABILITIES AND SUBSTANCE ABUSE 
SERVICES, APSM 95-2, (02/01/91), adopted in 
accordance with G.S. 1 SOB- 14(c). 

fbf Clients &f tbe afea program a»4 ite contract 
ag e ncies shall be informL ' d e4> th e ir rights a»4 the 
procedures fof appe - al if they feel tlwt- their rights 
have been infringed. 

fe} Each *teff member &f the afea program a&4 
e4> contract agencies shall be informed ef client 
rights *h4 procodures fof their protection. 

(b) As required bv G.S. 122C-142, each area 
program is responsible for assuring that any 
contract agency develops and implements poli- 
cies in accordance with CLIENT RIGHTS IN 
COMMUNITY MENTAL HEALTH, DE- 



VELOPMENTAL DISABILITIES AND SUB- 
STANCE ABUSE SERVICES, APSM 95-2. 



Statutory Authority G.S. 122C-61 through 
122C-63; 143B-147. 

.0434 CLIENT RIGHTS COMMITTEE 

(a) Each area board shall establish at least one 
Client Rights Committee. The area board shall 
also develop written policies a«4 procedures and 
implement policy which delineate: delineates: 

(1) composition, size, and method of ap- 
pointment of committee membership; 

(2) training and orientation of committee 
members; 



(6) 



(7) 



(8) 
(b) 



(3) frequency of meetings; 

(4) conducting meetings and voting proce- 
dures to be followed; 

(5) identification of all area program compo 
nonts aft4 contract agencies services which 
utilize intervention procedures specified in 
CLIENT RIGHTS IN COMMUNITY 
MENTAL HEALTH, DEVELOP- 
MENTAL DISABILITIES AND SUB- 
STANCE ABUSE SERVICES, APSM 
95-2, (02 . 01,91), Subchapter 14R, Section 
.0100; 

monitoring the effectiveness of existing 
and proposed methods and procedures for 
protecting the rights of clients; 
requirements for routine reports to the 
area board regarding seclusion, restraint 
and isolation time out; and 
other operating procedures. 
The Client Rights Committee shall oversee 
the implementation of the following client rights 
protections: 

(1) compliance with G.S. 122C, Article 3; 

(2) compliance with the provisions of Divi- 
sion publications CLIENT RIGHTS IN 
COMMUNITY MENTAL HEALTH, 
DEVELOPMENTAL DISABILITIES 
AND SUBSTANCE ABUSE SER- 
VICES, APSM 95-2 (02 01 91) and 
CONFIDENTIALITY RULES, APSM 
45-1, (01 10 86), adopted in accordance 
with G.S. 150B- 14(c); and 

(3) establishment of a review procedure for 
any of the following which may be 
brought by clients, client advocates, par- 
ents, guardians, staff or others: 

(A) client grievances; 

(B) alleged violations of the rights of indi- 
viduals or groups, including cases of al- 
leged abuse, neglect or exploitation; 

(C) concerns regarding the use of restrictive 
procedures; or 

(D) failure to provide needed services that 
are available in the area program. 

Nothing herein stated shall be interpreted to 
preclude or usurp the statutory authority of 
a county department of social services to 
conduct an investigation of abuse, neglect, 
or exploitation or the statutory authority of 
the Governor's Advocacy Council for Per- 
sons with Disabilities to conduct investi- 
gations regarding alleged violations of client 
rights, 
(c) The area board shall retain ultimate re- 
sponsibility for the assurance of client rights and 
shall establish a Client Rights Committee to 
serve in an advisory capacity to the area board. 
The Client Rights Committee shall include con- 



421 



6:8 NORTH CAROLINA REGISTER July 15, 1 99 1 



PROPOSED RULES 



sumer and family membership and each of the 
three disabilities must be represented on the 
committee. The Client Rights Committee shall 
not include a majority of area board members 
nor any person employed by the area program 
or any of its contract agencies. 

(d) The Client Rights Committee shall main- 
tain minutes of its meetings and shall file at least 
an annual report of its activities with the area 
board. Clients shall not be identified by name in 
either minutes nor written or oral reports. 

(e) The area board may transfer to the Client 
Rights Committee the responsibility for the 
Intervention Advisory Committee, as specified in 
Division publications CLIENT RIGHTS IN 
COMMUNITY MENTAL HEALTH, DE- 
VELOPMENTAL DISABILITIES AND SUB- 
STANCE ABUSE SERVICES, APSM 95-2, 
(02/01/91), adopted in accordance with G.S. 
150B-14(c). 

(f) Any area program which contracts for ser- 
vices shall delineate in the service contract the 
authority of the Client Rights Committee and its 
relationship to the contract agency. 

Statutory Authority G.S. 122C-64; 143B-147. 

SUBCHAPTER 18Q - GROUP HOMES FOR 

ADULTS WITH MENTAL RETARDATION OR 

OTHER DEVELOPMENTAL DISABILITIES 

SECTION .0700 - GROUP HOMES FOR 

ADULTS WITH MENTAL RETARDATION OR 

OTHER DEVELOPMENTAL DISABILITIES 

.0713 CROSS-REFERENCE TO MANAGING 
CLIENTS' FUNDS (REPEALED) 

Statutory Authority G.S. 143B-147. 

SECTION .0800 - APARTMENT LIVING 

PROGRAMS FOR ADULTS WITH MENTAL 

RETARDATION OR OTHER 

DEVELOPMENTAL DISABILITIES 

.0812 CROSS-REFERENCE TO MANAGING 
CLIENTS' FUNDS (REPEALED) 

Statutory Authority G.S. 143B-147. 

****************** 



No 



otice is hereby given in accordance with G.S. 
1 SOB- 1 2 that the DHR - Division of Aging intends 
to amend rule cited as 10 NCAC 22G .0408 and 
adopt rules cited as JO NCAC 22K .0101, .0201 - 
.0204; 22L .0101, .0201 - .0204; 22M .0101 - 
.0103, .020/ - .0206; 22N .0101, .0201 - .0212. 



1 he proposed effective date of 10 NCA C 22G 
.0408 is December J, 1991; 10 NCAC 22K - 22N 
is proposed to be effective on October 1, 1991. 

1 he public hearing will be conducted at 2:00 
p.m. on August 14, 1991 at the N.C. Division of 
Aging, 693 Palmer Drive, Room 127, Raleigh, NC 
27603. 

K^omment Procedures: Written comments con- 
cerning the proposed regulations must be submit- 
ted by August 14, 1991 to: Gary H. Cyrus, 
Division of Aging, Caller Box Number 29531 , 693 
Palmer Drive, Raleigh, NC 27626-0531. Oral 
presentations may be presented at the hearing. 
Any person may request information or copies of 
the proposed regulations by writing to: Mr. Gary 
Cyrus at the aforementioned address or by calling 
him at (919) 733-8399. 

CHAPTER 22 - AGING 

SUBCHAPTER 22G - PROGRAM OPERATIONS 

SECTION .0400 - TITLE VII NUTRITION 
PROGRAM 

.0408 DEFINITIONS OF SERVICES 

(a) The Division of Aging has established defi- 
nitions of the services eligible for funding under 
Title III of the Older Americans Act. Services 
to be operated by grantees and contractors with 
assistance from the Division shall be consistent 
with these definitions. 

(b) The Division of Aging's service definitions 
are as follows: 

(1) "Information and Referral" is aimed at 
providing the elderly with information 
about services available and assisting them 
in gaining access. The process involves: 

(A) maintenance of information about ser- 
vices and opportunities available; 

(B) employment of qualified staff to inform 
of services and opportunities and to assist 
in taking advantage of them; 

(C) identifying, with the client, the types of 
assistance needed, placing him or her in 
contact with the services, and following 
up. 

The Unit of Service is: a one to one 
contact. 

(2) "Outreach" is aimed at isolated elderly in 
need of available services who have not 
been able to use them. The process in- 
volves: 

(A) seeking out and identifying hard-to- 
reach individuals; 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



422 



PROPOSED RULES 



(3) 



(4 



(5 



(6) 



(B) assisting those identified to gain access 
to these services. 

The Unit of Services is: a home visit. 
"Transportation" enables elderly persons 
to go to and from facilities and resources 
in order to apply for and receive services, 
reduce isolation, and promote independ- 
ent living. Delivery may vary from 
county to county based on availability of 
transportation resources. 
The Unit of Service is: a one way trip. 

"Counseling" provides direct guidance 
and assistance by qualified professional 
staff in copying with personal problems 
(family, emotional, psychological) and is 
generally offered as a special service in the 
focal agency for the elderly or is con- 
tracted to a specialized agency. 
The Unit of Service is: 

Group = staff - hour 

Individual = person - hour 

"Health Screening" is a preventive and 
maintenance service provided by trained 
personnel and includes: 

(A) maintaining individual health history; 

(B) basic examination; 

(C) testing for diabetes, glaucoma, abnor- 
mal blood pressure, etc.; 

(D) evaluation and counseling; 

(E) referral to other agencies and follow-up. 
The Unit of Service is: a case hour. 
"Homemaker" services aw supportive set- 
vices provided by qualified para 
prof e ssionals who a*e trained, equipped , 
aligned, w+4 supervised by professionals 
within tbe agency to help maintain, 
strengthen. aft4 safeguard the ea» ef the 
elderly "m their own homes. These sef- 
vices must, at- a minimum, meet standards 
established by toe North Carolina Divi 
sie» ef Social Services. Department ef 
Human Resources. Services include: 
providing assistance m management ef 
household budgets; planning nutritious 
meals; purchasing a»4 preparing foods; 
housekeeping duties; consumer education; 
aft4 basic p e rsonal <±«4 health care, with 
tbe focus ef avoiding unnecessary a«4 es- 
pensive institutionalization. A» emphasis 
is placed e» meeting the standards el the 
National Home Caring Council. "In- 
Home Aide Services" are those 
paraprofessional services which assist the 
individual, his family or both with essen- 
tial home management tasks, personal 
care tasks, or supervision, or all of the 
above, to enable the individual, his family. 
or both to remain, and function effec- 



tively^ at home as long as possible. In- 
Home /Vide Services may be used for the 
purpose of providing respite for a primary 
caregiver. For this purpose, In-Home 
Aide Services may be provided to a client 
or patient in his own home or in the home 
of his primary caregiver. Respite Care 
may consist of any level of home man- 
agement or personal care tasks. 
The Unit of Service is: an hour of service, 
f?) "Chore" services include the performance 
ef tasks incidental te activities ef daily 
living which 4e aet require the services 
ef a trained homemaker ef other special 
ist-r as currently defined by the North 
Carohna Division ef Social Services. 
Such services a» provided to enable indi 
viduals to remain tft their own homes a«4 
includ e : assistanc e i» meeting basic ea*e 
needs such as meal preparation; shopping 
top food aft4 other necessities; running 
necessary ' e rrands; providing transporta 
ttoft to essential servic e facilities; ea*e a«4 
cleaning ef the house, grounds, clothing, 
an4 linens; afnA minor repairs to toe 
hous e , furnishings, only if provided under 
professional sup e rvision a«4 if chore 
workers , hase received proper training fef 
such tasks. Preferably, chore workers 
should be agency employees. 
The Unit ef Services k* a** hour ef set- 

(7) f&+ "Home Health" services include health 
care prescribed by a physician and given 
in the home. Such services may include: 

(A) skilled nursing care; 

(B) occupational, physical, and speech 
therapy; 

(C) special services to blind and visually 
handicapped; 

(D) nutritional guidance; 

(E) medical social work; and 

(F) a home health aide. 

The Unit of Service is: an hour of service. 

(8) (% "Housing Assistance" includes services 
to obtain or maintain adequate housing; 
Component 1 includes direct provision 
and supervision of repairs (home reno- 
vation, weatherization). Component 2 
involves location of funding for repairs, 
assistance in applying for funds, and 
follow-up to see that senice was delivered. 
Component 3 assists the client in relo- 
cation to more suitable housing. 

The Unit of Services is: a case hour. 

(9) (44) "Legal" services provide individual 
legal advice or representation in civil mat- 
ters by an attorney. Thev may include, 



423 



6:S NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



but may not be limited to, a component 
involving advice or representation by: 

(A) a paralegal under the supervision of an 
attorney; 

(B) a third year law student under the 
supervision of an attorney; or 

(C) a non-lawyer in administrative public 
benefits problems. The Unit of Service is: 
one case hour of direct legal services. 

(10) (444 "Employment Referral" is a referral 
designated to help individuals find em- 
ployment or link them with training pro- 
grams that would qualify them for 
employment. Such services include: 

(A) provision of information about job 
opportunities; 

(B) counseling with individuals prior to re- 
ferral; 

(C) helping employers create an environ- 
ment for acceptance of the elderly and 
linking particular individuals with specific 
opportunities; 

(D) working with employers to create job 
opportunities for the elderly; 

The Unit of Service is: a case hour. 

(1 1) (4-3) "Nutrition Services" include the 
range of services provided for and made 
accessible to nutrition program partic- 
ipants. Services may include: the pro- 
vision of a hot meal, meeting one-third of 
the Recommended Dietary Allowances of 
the National Research Council, in a con- 
gregate setting or delivered to an individ- 
ual in the home; modification in the 
regular diet if sufficient numbers of per- 
sons have the need and if the food and 
skills are available to meet the need; and 
education in nutrition. 

The Unit of Service is: a meal provided. 

(12) (444 "Day Care Services" include an or- 
ganized program of services during the day 
in a community group setting for sup- 
porting the personal independence, and 
promoting the social, physical, and emo- 
tional well-being of older adults who do 
not need nursing care but who require 
complete, full-time supervision during the 
day in order to live in their own home or 
the home of a relative or older adults. 
These are individuals who need help with 
activities of daily living to maintain them- 
selves in their own homes or older adults 
who need intervention in the form of 
enrichment and opportunities for social 
activities in order to prevent deterioration 
that would lead to placement in group 
care. Included in these services are med- 



ical examinations required for individual 
participants for admission to day care and 
periodically thereafter when not otherwise 
available without cost, food and food ser- 
vices to provide a nutritional meal and 
snacks as appropriate to the program, and 
transportation to and from the service fa- 
cility when needed and not otherwise 
available. Services must be provided in a 
center certified as meeting state standards 
for such programs. 
The Unit of Service is: a person-day. 

(13) (44) "Case Management" is a service de- 
signed to provide professional assessment 
of the total needs of an older adult and the 
planning, acquisition, coordination, and 
monitoring of all services required to meet 
the needs of the older adult from all ser- 
vice agencies in the community. 

The Unit of Service is: a case hour. 

(14) (44) "Recreation Services" are organized 
activities that offer individuals the oppor- 
tunity to use their leisure time in creative, 
enjoyable, and self-fulfilling experiences. 
A well-balanced program shall include 
active and passive services that offer 
physical, mental, social, cultural, and 
other opportunities for experiences and 
expression. Proper planning and coordi- 
nation should maximize the efficient use 
of all community resources--i.e., facilities, 
leaders, participants and agencies. The 
services should be responsive to the 
unique and varied needs and desires of the 
potential participants. Recreation services 
include such activities as sports, music, 
drama, dance, arts and crafts, nature 
study, physical fitness, table games, tours, 
gardening, and camping. 

The Unit of Service is: a person-hour, 
(c) For purposes of these definitions, the units 
of service measures will be applied as follows: 

(1) Case hour - an hour of time spent work- 
ing on a case, regardless of whether the 
time is spent with a client or not. Work 
not related to a specific client would not 
be included in this definition. 

(2) Hour of Service - an hour of time spent 
in direct service at a client's home includes 
travel time to home. 

(3) Person-hour - an hour of time spent with 
a single client. Person-hours related to 
the provision x>f service to a group of cli- 
ents would equal the number of hours 
spent with the group in service provision 
times the number of persons present at 
the time of sendee delivery. 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



424 



PROPOSED RULES 



(4) Staff-hour - an hour of staff time spent 
on any activity related to the service iden- 
tified.' 

Statutory Authority G.S. USB- 10; 143B-138. 

SUBCHAPTER 22K - INSTITUTIONAL RESPITE 
CARE SERVICE 

SECTION .0100 -SCOPE OF INSTITUTIONAL 
RESPITE CARE 

.0101 SCOPE OF INSTITUTIONAL RESPITE 
CARE SERVICE 

Primary Service. Institutional Respite Care 
Service is temporary placement of an individual 
who requires constant care or supervision, or 
both, out of his or her home to provide the pri- 
mary, unpaid caregiver temporary relief from 
caregiving responsibilities. 



Statutory Authority 
143B-181.10. 



G.S. 143B-18I.l(c); 



Statutory Authority 
143B-181.I0. 



G.S. I43B-181.I(c); 



SECTION .0200 - SERVICE PROVISION 

.0201 SCREENING OF CLIENT 

(a) Screening is a preliminary process used to 
determine if client eligibility is met. 

(b) A screening instrument must be completed 
for each unpaid primary caregiver who requests 
service. 

(c) The screening instrument must address: 
( 1 1 Caregiver identification information; 

Ability of the person requiring care to 
perform activities of daily living; 

Ability of the person requiring care to 
perform instrumental activities of daily 
living; 

Physical functioning of the person requir- 
ing care; 

Caregiver's perception of the emotional 
well-being of the person requiring care; 
Extent of support provided by the primary 
caregiver; 

Services currently received by the person 
requiring care or the caregiver. 



(2) 
(3) 

(4) 
(5) 
(6) 
(7) 



Statutory Authority 
143B- 181.10. 



G.S. 143B-I81.1(c); 



.0202 HOME VISIT 

(a) A home visit shall be made to verify infor- 
mation obtained during the screening process. 

(b) The screening instrument must be signed 
and dated by the person conducting the home 
visit and filed in the client record. 



.0203 SERVICE PLANS 

(a) A service plan shall be maintained by the 
service provider agency for each person requiring 
constant care or supervision, or both. 

(b) The service plan shall indicate the tasks to 
be provided in the absence of the caregiver. 

(c) The service plan must be dated and signed 
by the caregiver and the professional responsible 
for developing the service plan. 



Statutory Authority 
143B-I81.10. 



G.S. I43B-18I.l(c); 



.0204 DOCUMENTATION/RECORDS FOR/ 
PERSON REQ CONSTANT CARE OR 
SUPVN 

(a) Records shall include a completed copy of 
the screening instrument, documentation of 
home visit, and service plan. 

(b) An emergency contact person must be 
identified and maintained in the client record. 



Statutory A uthority 
143B-18LI0. 



G.S. 143B-181.1(c); 



SUBCHAPTER 22L - INFORMATION AND 
CASE ASSISTANCE 

SECTION .0100 - SCOPE OF INFORMATION 
AND CASE ASSISTANCE 

.0101 SCOPE OF INFORMATION AND CASE 
ASSISTANCE 

Information and Case Assistance is identified as 
a critical service which assists older adults, their 
families and others acting on behalf of older 
adults, in their efforts to acquire information 
about programs and services and to obtain ap- 
propriate services to meet their needs: 

(1) "Information" includes informing people 
about programs and services, identifying the 
types of assistance they need and connecting 
them to appropriate service providers. 

(2) "Case Assistance" is a more intensive ser- 
vice for those persons who require additional 
assistance with negotiating the service deliv- 
ery system. Case Assistance is the provision 
of referral, follow-up and advocacy activities 
on behalf of the older adult or their family, 
or both, to ensure that needed assistance is 
received and that the assistance provided 
meets identified needs. Case Assistance may 
also include a home visit to more clearly 
identify a client's needs for the purpose of 
initiating the development of a care plan for 
clients who do not have health related needs. 



425 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



Statutory Authority G.S. 143B-181 .1 (c). 

SECTION .0200 - SERVICE PROVISION 

.0201 ELIGIBILITY FOR INFORMATION 
AND CASE ASSISTANCE 

Those eligible for Information and Case Assist- 
ance Services are persons 60 years of age and 
older or persons acting on behalf of persons age 
60 and older, or both, who are in need of infor- 
mation or services, or both. 

Statutory Authority G.S. 143B- 181 .1(c). 

.0202 RESOURCE FILE 

(a) The agency providing Information and Case 
Assistance shall cooperatively develop, maintain, 
and use an accurate, up-to-date resource file that 
contains information on available community 
resources. The Information and Case Assistance 
provider shall update the resource file annually 
by survey or on-site visits. 

(b) A profile shall be developed on each sendee 
organization and agency that shall include, but is 
not limited to: the legal name, common name, 
or acronym; address; telephone number; hours 
and days of service; services provided; area 
served; branch offices; known barriers to accessi- 
bility and restrictions on facility use. 

Statutory Authority G.S. 143B-181 .1 (c). 

.0203 TRAINING 

The agency providing Information and Case 
Assistance shall make orientation and in-service 
training available to paid and volunteer staff. 

(1) Staff shall participate in an orientation 
program which, at a minimum, reviews the 
role, purpose, and function of Information 
and Case Assistance; the role of the agency; 
and the administrative structure and policies 
for providing the service. 

(2) Agencies shall also provide in-service edu- 
cation and on-the-job training to staff which 
focuses on the development of interviewing 
techniques and communication skills. 

Statutory Authority G.S. 143B-181 .1 (c). 

.0204 DOCUMENTATION 

(a) Each agency providing Information and 
Case Assistance shall maintain a daily log indi- 
cating contacts made during the course of the 
day. 

(b) The log shall include the date and general 
nature of the call. 

(c) For those persons who receive Case As- 
sistance, a client record shall be maintained by 



the agency and shall include: client identification 
information; identification of client needs; a list 
of agencies to whom the client was referred and 
dates; and follow-up contacts made to or on be- 
half of the client and the dates. 

Statutory Authority G.S. 143B-I81 .1 (c). 

SUBCHAPTER 22M - CARE MANAGEMENT 

SECTION .0100 - SCOPE OF SERVICE 

.0101 SCOPE OF CARE MANAGEMENT 

Primary Service. Care Management is a coor- 
dinated care function which incorporates case 
finding, assessment and reassessments, negoti- 
ation, care plan development and implementa- 
tion, monitoring, and advocacy to assist 
functionally impaired older adults with complex 
care needs in obtaining the services necessary to 
be safely cared for within the home and commu- 
nity setting. 

Statutory Authority G.S. 143B- 181 .1 (c). 

.0102 DEFINITIONS 

As used in this Subchapter, the following terms 
shall have the meanings specified: 

(1) "Activities of daily Living (ADL's)" include 
eating, dressing, bathing, toileting, bowel 
and bladder control, transfers, ambulation, 
and communication such as ability to ex- 
press needs to others through speech, writ- 
ten word, signing, gestures, or 
communication devices. 

(2) "Instrumental activities of daily living 
(IADL's)" include meal preparation, 
medication intake, house cleaning, money 
management, telephone use, laundering, 
reading, writing, transportation, mobility, 
shopping, and going to necessary activities. 

(3) "Case closure" means the discontinuation 
of Care Management Services when the 
goals of the care plan have been met or 
when the client is no longer eligible for Care 
Management Services. 

Statutory Authority G.S. 143B-181 .1(c). 

.0103 TARGET POPULATION 

The target population consists of functionally 
impaired older adults who are at risk of abuse, 
neglect, exploitation, or have complex care needs, 
or both; and who, due to a critical time factor 
or the complexity of services needed, are unable 
to access needed services in order to remain safely 
at home. 

Statutory Authority G.S. I43B-181 .1(c). 



6:S NORTH CAROLINA REGISTER July 15, 1991 



426 



PROPOSED RULES 



SECTION .0200 - SERVICE PROVISION 

.0201 CLIENT ELIGIBILITY 

Care Management Services are limited to older 
adults 60 years of age or older and their spouses 
who meet the identified target population. 

Statutory Authority G.S. 1 43 B- IS 1.1 (c). 

.0202 SCREENING 

(a) Screening is a preliminary process used to 
determine if an individual appears to belong in 
the target population. 

(b) A screening instrument must be completed 
for each person requesting Care Management 
Services. 

Statutory Authority G.S. 143B-1S1.1 (c). 

.0203 ASSESSMENT AND REASSESSMENT 

(a) The assessment and reassessment are com- 
prehensive multidimensional methods used to 
determine the client's level of functioning and 
confirm eligibility for Care Management Services. 

(b) The initial assessment and all reassessments 
shall be conducted in the client's home and shall 
address the mental, social, environmental, eco- 
nomic, and physical health status of the client, 
as well as the ability to perform activities of daily 
living (ADL's) and instrumental activities of daily 
living (IADL's). 

(c) The assessment and reassessment shall be 
conducted in the client's home by a Social 
Worker and a Registered Nurse. 

(d) A full reassessment shall be completed at 
least every 12 months or as the client's condition 
warrants. 

(e) The initial assessment and reassessments 
shall be signed and dated by the Social Worker 
and the Registered Nurse and shall be maintained 
in the client's file. 

Statutory Authority G.S. 143B-1S1 .1 (c). 

.0204 CARE PLANNING 

The purpose of the care plan is to identify the 
course of action to be followed: 

( 1 ) Care plans for an eligible client shall be 
developed within 12 working days of the in- 
itial screening. 

(2) The care plan shall include, at a minimum, 
the following information: 

(a) Outcome oriented goal statements and 
conditions for case closure; 

(b) Both formal and informal services to be 
provided; 

(c) Agencies responsible for service provision; 



(d) Frequency of service provision; 

(e) Duration of service provision; 

(f) Signature of the client or designated repre- 
sentative indicating agreement with the 
care plan; 

(g) Signature of the Registered Nurse and the 
Social Worker developing the care plan; 

(h) Date of care plan development. 

(3) Care plans shall be reviewed at least quar- 
terly or more frequently as the client's con- 
dition warrants by both the Social Worker 
and the Registered Nurse. 

(4) All changes to the care plan must be docu- 
mented and dated on the care plan by the 
Social Worker and Registered Nurse, or 
both. 

Statutory Authority G.S. 143B-I81 .1 (c). 

.0205 MONITORING 

The purpose of monitoring is to guarantee 
continuity of services and to evaluate the client's 
continued eligibility for Care Management Ser- 
vices: 

(1) At a minimum, a monthly contact must be 
made to the client. 

(2) At least one contact per quarter must be 
conducted in the client's home. 

(3) All monitoring activities must be docu- 
mented in the client's file by the appropriate 
professional. 

Statutory Authority G.S. MSB- 181 .1 (c). 

.0206 DOCL MENTATION 

Client records for Care Management Services 
shall include: 

(1) A completed copy of the screening instru- 
ment; 

(2) A completed copy of the initial assessment; 

(3) Completed copies of all reassessments; 

(4) Copies of the initial and any revised care 
plans; 

(5) Documentation of all monitoring activities; 

(6) Denial, termination or reduction of service 
when appropriate; 

(7) Documentation of client's approval for re- 
lease of information. 

Statutory Authority G.S. 143B-181 .1 (c). 

SUBCHAPTER 22N - CONFIDENTIALITY OF 
CLIENT DATA 

SECTION .0100 - DEFINITIONS FOR 
CONFIDENTIALITY OF CLIENT DATA 

.0101 DEFINITIONS FOR CONFIDENTIALITY 
OF CLIENT DATA 



427 



6:8 SORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



Unless the context clearly specifies otherwise, 
the following terms are defined as follows: 

(1) "Agency" means Division of Aging, Area 
Agencies on Aging, or service provider. 

(2) "Client" means any applicant for, or recip- 
ient of, services administered under the aus- 
pices of the Division of Aging, or someone 
who makes inquiries, is interviewed, or is or 
has been otherwise served to some extent by 
the agency. 

(3) "Client information" or "client record" 
means any information, whether recorded 
or not, including information stored in 
computer data banks or files, relating to a 
client which was received in connection with 
the performance of any function of the 
agency. 

(4) "Court order" means any oral order from 
a judge or a written document from a judi- 
cial official which directs explicitly the re- 
lease of client information. 

(5) "Service provider" means any public or 
private agency from whom Division of Ag- 
ing funded services are purchased or author- 
ized. 

Statutory Authority G.S. 143B-181 .1 (c). 

SECTION .0200 - REQUIREMENTS 

.0201 CONFIDENTIALITY OF CLIENT DATA 

(a) Client information obtained by the Division 
of Aging, Area Agencies on Aging or service 
providers from an older person or their desig- 
nated representative shall not be disclosed in a 
form that identifies the person without the in- 
formed consent of the person or legal represen- 
tative unless the disclosure is required by court 
order, or for program monitoring by authorized 
federal, state, or other designated monitoring 
agencies. 

(b) The agency shall assure that all authorized 
individuals are informed of the confidential na- 
ture of client information and shall disseminate 
written policy to and provide training for all per- 
sons with access to client information. 

Statutory Authority G.S. 143B-181 .1 (c). 

.0202 INFORMATION FROM OTHER 
COMMUNITY SERVICE 
ORGANIZATIONS 

If the agency receives information from another 
community service organization or individual, 
then such information shall be treated as any 
other information generated by the State Divi- 
sion of Aging, Area Agency on Aging or service 
provider and disclosure thereof will be governed 



by any condition imposed by the furnishing 
community service organization or individual. 

Statutory Authority G.S. 143B-181 .1 (c). 

.0203 DISCLOSURE PURSUANT TO OTHER 
LAWS 

Whenever federal or state statutes or regulations 
specifically address confidentiality- issues, the 
agency shall disclose or keep confidential client 
information in accordance with those federal or 
state statutes or regulations. 

Statutory Authority G.S. I43B-I81 .1 (c). 

.0204 OWNERSHIP OF RECORDS 

All client information contained in any records 
of the agency is the property of the, agency. 
Employees of the agency shall protect and pre- 
serve such information from dissemination ex- 
cept as indicated by the policies established. 

Statutory Authority G.S. 143B-181 .1 (c). 

.0205 SECURITY OF RECORDS 

(a) The agency shall provide a secure place with 
controlled access for the storage of client records 
or reports, or both, which contain client specific 
information. 

(b) Only employees, students, volunteers or 
other individuals who must access client infor- 
mation in order to carry out duties assigned or 
approved by the agency shall be authorized to 
have access to such information. 

(c) Only authorized individuals may remove a 
record or report, or both, from the storage area 
and that individual shall be responsible for the 
security of the record until it is returned to the 
storage area. 

(d) The agency shall be allowed to destroy re- 
cords in accordance with Record Retention 
Schedules promulgated by the Division of Ar- 
chives and History, and state and federal statutes 
and regulations. 

(e) The Division of Aging, Area Agencies on 
Aging and service providers shall establish writ- 
ten procedures to prevent accidental disclosure 
of client information from automated data proc- 
essing systems. 

Statutory Authority G.S. 143B-181 .1 (c). 

.0206 RELEASE OF CLIENT INFORMATION 

(a) No client identifying information, except 
as referenced in Rule .0205 of this Section, which 
is maintained by the Division of Aging, Area 
Agency on Aging or service provider shall be re- 
leased to other individuals or community sendee 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



428 



PROPOSED RULES 



organizations without obtaining a signed consent 
for release of information from the client or legal 
guardian. 

(b) The consent for release of information shall 
include, at a minimum, the following items: 

(1) Name of the provider and recipient of the 
information; 

(2) The extent of information to be released; 

(3) The name and dated signature of the client 
or client representative; 

(4) A statement that the consent is subject to 
revocation at any time except to the ex- 
tent that action has been taken in reliance 
on the consent; 

(5) Length of time the consent is valid. 

(c) The client may alter the form to contain 
other information which may include but is not 
limited to: 

(1) A statement specifying the date, event or 
condition upon which the consent may 
expire even if the client does not expressly 
revoke the consent; 

(2) Specific purpose for the 'release. 

(d) A copy of the signed consent for release of 
information shall be maintained in the client re- 
cord. 

Statutory Authority G.S. 143B-181 .1 (c). 

.0207 INFORMED CONSENT 

Prior to obtaining a consent for release of in- 
formation, the delegated representative shall ex- 
plain the meaning of informed consent. The 
client shall be told the following: 

(1) Contents to be released; 

(2) That there is a definite need for the infor- 
mation; 

(3) That the client can give or withhold the 
consent and the consent is voluntary: 

(4) That there are statutes and regulations 
protecting the confidentiality of the infor- 
mation. 

Statutory Authority G.S. 143B-181 .1 (c). 

.0208 CLIENT ACCESS TO RECORDS 

(a) Confidentiality of information about him- 
self is the right of the client. Lpon written or 
verbal request, the client shall have access to re- 
view or obtain without charge a copy of the in- 
formation in his records with the following 
exceptions: 

( 1 ) Information that the agency is required to 
keep confidential by state or federal stat- 
utes or regulations; 

(2) Confidential information originating from 
another communitv service organization; 



(3) Information that would breach another 
individual's right to confidentiality. 

(b) Client's requesting access to the informa- 
tion contained in his record as promptly as fea- 
sible but no more than five working days after 
receipt of the request. 

(c) The Director or his delegated representative 
shall be present when the client reviews the re- 
cord. 

(d) The Director or his delegated representative 
must document in the client record the review of 
the record by the client. 

Statutory Authority G.S. 143B-18I .1 (c). 

.0209 CONTESTED INFORMATION 

(a) A client may contest the accuracy, com- 
pleteness or relevancy of the information in his 
record. 

(b) A correction of the contested information, 
but not the deletion of the original information 
if it is required to support receipt of state or fed- 
eral financial participation, shall be inserted in 
the record when the Director or his designee 
concurs that such correction is justified. 

(c) When the Director or his delegated repre- 
sentative does not concur, the client shall be al- 
lowed to enter a statement in the record. 

(d) Such corrections and statements shall be 
made permanent part of the record and shall be 
disclosed to any recipient of the disputed infor- 
mation. 

(e) If a delegated representative decides not to 
correct contested information, the decision not 
to correct shall be reviewed by the supervisor of 
the person making the initial decision. 

Statutory Authority G.S. 143B-181 .1 (c). 

.0210 WITHHOLDING OF INFORMATION 
FROM THE CLIENT 

(a) WTien the Director or delegated represen- 
tative determines on the basis of the exceptions 
outlined in Rule .0208 of this Section to withhold 
information from the client record, this reason 
shall be documented in the client record. 

(b) The Director or delegated representative 
must inform the client that information is being 
withheld, and upon which of the exceptions 
specified in Rule .0208 of this Section the deci- 
sion to withhold the information is based. 

(c) If confidential information originating from 
another community service organization is being 
withheld, the client shall be referred to that 
community service organization for access to the 
information. 

Statutory Authority G.S. 143B-181 .1 (c). 



429 



6:S NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



.0211 DISCLOSURE OF CLIENT 

INFORMATION WITHOUT CLIENT 
CONSENT 

Client information included in the client record 
may be disclosed without the consent of the cli- 
ent under the following circumstances: 

(1) To other employees of the agency for the 
purpose of making referrals, supervision, 
consultation or determination of eligibility. 

(2) Between the service provider, Area Agency 
on Aging and Division of Aging for the 
purposes of reporting. 

Statutory Authority G.S. 143B-1SI .1 (c). 

.0212 INFORMATION NEEDS OF SERVICE 
PROVIDERS 

(a) Client information may be disseminated to 
service providers in accordance with the release 
of information statement included on the client 
registration form. 

(b) Any further disclosure will require a signed 
release of information form from the client. 

Statutory Authority G.S. 143B-1SI .1 (c). 

****************** 



iv otice is hereby given in accordance with G.S. 
I SOB- 12 that the Department of Human 
Resources Division of Medical Assistance intends 
to amend rule(s) cited as 10 NCAC SOB .0312. 

1 he proposed effective date of this action is No- 
vember 1 , 1991 . 

1 he public hearing will be conducted at 1:30 
p.m. on August 15, 1991 at the North Carolina 
Division of Medical Assistance, 1985 Urns lead 
Drive, Room 297, Raleigh, N. C. 27603. 



Co 



comment Procedures: Written comments con- 
cerning this amendment must be submitted by 
August 15, 1991, to: Dh-ision of Medical Assist- 
ance, 1985 Umstead Drive, Raleigh, N. C. 27603, 
ATTN.: Bill Hottel, A PA Coordinator. Oral 
comments may be presented at the hearing. In 
addition, a fiscal impact statement is available 
upon written request from the same address. 

CHAPTER 50 - MEDICAL ASSISTANCE 

SUBCHAPTER 50B - ELIGIBILITY 
DETERMINATION 

SECTION .0300 - CONDITIONS FOR 
ELIGIBILITY 



(2) 



(bl 



.0312 TRANSFER OF RESOURCES 

In accordance with 42 U.S.C. 1396p(c), an in- 
dividual who transfers resources and receives 
compensation that is less than the fair market 
value may be ineligible to receive nursing facility 
services. 
(1) As provided for by P.L. 100-360, Section 
303(g) amended by P.L. 100-485, Section 
608(d)(16)(D), the provisions of 42 U.S.C. 
1396p(c) shall be effective for all transfers of 
resources, except transfers between spouses, 
occurring on or after July 1, 1988. The 
provisions of 42 U.S.C. 1396p(c) shall be 
effective for transfers between spouses, oc- 
curring on or after October 1, 1989. 

As allowed under 42 U.S.C. 
1396p(c)(2)(D), the provisions of 42 U.S.C. 
1396p(c) for ineligibility for nursing homo 
services due to transfer of resources shall not 
be applied: 

i} To ie- individuals who transferred re- 
sources after July 1, 1988 and before 
March 15, 1989 and were found eligible 
pnor to March 15, 1989; 
When it is determined by the agency's 
judgment that the applicant or recipient 
is a victim of fraud and did not take the 
action with the intent of becoming eligible 
for Medicaid. 

Authority G.S. 10SA-54; 108A-58; P.L. 100-360; 
PL. 100-485; 42 U.S.C. 1396p(c); 42 C.F.R. 
435.121; 42 C.F.R. 435.840; 42 C.F.R. 435.841; 
42 C.F.R. 435.845. 

TITLE 11 - DEPARTMENT OF 
LNSURANCE 



1 V otice is hereby given in accordance with G.S. 
150B-12 that the N.C. Department of Insurance 
intends to amend rule(s) cited as 1 1 NCAC 12 
.0306 - .0307, .03/2, .0317, .0321 - .0323, .0420, 
.0426 - .0427, .0431, .0434, .0447 - .0448, .0507, 
.0514, .0517, .0526. .0553, .0555 - .0557; repeal 
rule(s) cited as 11 NCAC 12 .0303, .0305, .0318, 
.0402, .0414, .0504, .0527, .0537, .0554, .055S; 
and adopt rule(s) cited as 11 NCAC 12 .0325 - 
.0326, .0458 - .0460, .0559, .1101 - .1108. .1201 - 
.1211. 

1 he proposed effective date of this action is No- 
vember 1, 1991. 

1 he public hearing will be conducted at 10:00 
a.m. on August 14. 1991 at the Dobbs Building. 



6:8 NORTH CAROLINA REGISTER July 15, 1 99 1 



430 



PROPOSED RULES 



3rd Floor Hearing Room, 430 N. Salisbury Street, 
Raleigh, N.C. 27611. 

K^omment Procedures: Written comments may 
be sent to Susan Goff, P.O. Box 26387, Raleigh, 
N.C. 2761 1 . Oral presentations may be made at 
the public hearing. Anyone having questions 
should call Susan Goff at (919) 733-5060 or Ellen 
Sprenkel at (919) 733-4700. 

CHAPTER 12 - LIKE AND HEALTH DIVISION 

SECTION .0300 - GENERAL PROVISIONS 

.0303 REBATES ON INSURANCE 
COMPANIES EMPLOYEES: 
PROHIBITED (REPEALED) 

Statutory! Authority G.S. 58-54.4(8). 

.0305 TWISTING OR OTHER PRACTICES 
INJURIOUS TO THE PUBLIC 
(REPEALED) 

Statutory Authority G.S. 58-9(1); 58-42.1; 
58-54.4. 

.0306 LIFE: HEALTH AND ACCIDENT 

COVERAGES: POLICY OUT OF STATE 

Where a group master policy is written upon 
application taken outside this jurisdiction cover- 
ing individuals in this state the certificate covering 
lives within this state shall he considered "North 
Carolina business" and reported through the of- 
fice of some general agent, resident in or having 
territory within the state. This Rule does not 
apply to group mortgage and blanket scholastic 
policies where the policy must be issued in North 
Carolina. 

Salaried home office group representatives wttt 
be permitted te- assist m talcing applications fo* 
certificates under a master policy only when such 
home offic e representatives afe accompanied by 
a duly licensed resident agent. 

Statutory Authority G.S. 58-3-1; 58-2-40. 

.0307 FILING APPROVAL: LIFE: 

ACCIDENT AND HEALTH FORMS 

(a) All life, annuity, accident and health and 
health maintenance organization forms must be 
filed with and approved by the Commissioner 
before use. 

(b) The following procedure should be used in 
filing life, annuity, and accident and health and 
health maintenance organization forms for ap- 
proval by this Department: 

(1) Filing letter should be submitted in du- 
plicate with the Federal Employee Iden- 



tification Number (FEIN); list forms by 
number and descriptive title; indicate if 
new and briefly describe use of form; if 
revision identify form being replaced by 
number and approval date; 

(2) If riders, endorsements or certificates are 
filed separately, indicate policy forms with 
which they are used; 

(3) Only one copy of the form, is required to 
be submitted unless the company desires 
a stamped copy; 

(4) All forms should be completed with 
specimen data; 

(5) Rates by age and mode of payment in- 
cluding the actuarial memorandum should 
be attached to each form requiring a pre- 
mium; 

(6) Submit evidence of approval of subject 
identical filing by the state of domicile; 

(7) Submit a listing of states in which subject 
identical filing has been submitted and a 
listing of states which have: 

(A) approved; or 

(B) disapproved, including the reasons for 
disapproval; 

(8) Submit copies of any endorsements, riders 
or changes in subject filing required by 
any jurisdiction as a condition of ap- 
proval; 

(9) Subparagraphs (6), (7), and (8) of this 
Paragraph shall not be applicable to do- 
mestic insurers; 

(10) Submit copies of sales promotion mate- 
rial to be used in North Carolina for an- 
nuities and interest sensitive life products. 

(c) Premium rate revisions must be filed in 
triplicate, and include evidence of this Depart- 
ment's most recent approval of the policy rate 
revision. 

(d) Remittance of filing fee shall be within 45 
days of filing fee notice or the file will be closed. 

(e) The status of forms and rates filed with this 
Department must be requested in writing bv the 
filer concerning forms and rates not acted upon 
within 60 davs after the date of the filing letter. 

(f) A wntten notice must be given to the De- 
partment of Insurance by the filer prior to 
deeming tonus and rates approved. 

Statutory Authority G.S. 58-2-40; 58-6-5; 
58-51-1; 58-58-1; 58-65-1; 58-65-40. 

.0312 ACCIDENTAL DEATH BENEFIT: 
INHALATION OF GAS: ETC 

A policy or rider providing benefits for acci- 
dental death may not exclude the involuntary 
inhalation t4~ s** *h4 fumes *«4 involuntary tak- 
ing trf poison, ^ef may it- exclud e accidental 



431 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



death as a result ef involuntary e xposure to nu- 
clear explosion, nuoloar onorgy »f nuclear eie- 
monts. following: 

(1) The involuntary inhalation of gas and 
fumes and the involuntary taking of poison. 

(2) Accidental death as a result of involuntary 
exposure to nuclear explosion, nuclear en- 
ergy or nuclear elements. 

(3) The involuntary exposure to hazardous 
waste and other toxins. 



(4) Unintentionally self-inflicted bodily injury. 

(5) Bacterial injection resulting from accidental 
injury. 

(6) Accidental ingestion of ptomaine. 



Statutory Authority G.S. 58-2-40; 58-51-95. 

.0317 ORIGIN OF SICKNESS: DESCRIPTION 

The use of a term more restrictive than "first 
manifested" in the determination of when a dis- 
ease or sickness begins is prohibited. The term 
"prudent person" cannot be used as a condition 
to establish when a disease or sickness begins. 

Statutory Authority G.S. 58-2-40; 58-51-95; 
58-58-1; 58-65-1; 58-65-40; 58-67-1; 58-67-/50. 

.0318 PREMIUM INCREASES: GROUP 
(REPEALED) 



Statutory Authority G.S. 57-1; 
58-195; 58-249; 58-254.7; 58-293. 



57-4: 58-9; 



.0321 RATE FILING: HMO 

(a) All schedules of premiums for enrollee 
coverage for health care services, or amendment 
thereto, shall be filed in duplicate in accordance 
with 11 NCAC 12 .0307(b)(5), indicating 
whether the schedule is original or amended. 

(b) All filings shall be accompanied by: 

(1) A certification by the chief executive offi- 
cer of the corporation that the premiums 
applicable to an enrollee are not individ- 
ually determined" based on the status of 
his health; 

(2) A certification by an actuarial expert that 
such premiums are established in accord- 
ance with actuarial principles for various 
categories of enrollees and are not exces- 
sive, inadequate, or unfairly 
discriminatory; 

(3) Actuarial data supporting the schedule of 
premiums; 

(4) Such other data deemed necessary by the 
commissioner to determine whether to 
approve or disapprove the filing; 

(5) Actuarial data and rates must be fded in 
triplicate. 



Statutory Authority G.S. 58-67-50; 58-67-150. 

.0322 REGULAR CARE AND ATTENDANCE 
OF A PHYSICIAN 

As used in life, accident and health and disabil- 
ity policies, "regular care and attendance of a 
physician" shall not be construed to require in- 
sureds to see or be under the care of a physician 
on a regular basis if it can be shown that the in- 
sured has reached his maximum point of recov- 
ery yet is still disabled under the terms of the 
insurance contract. This requirement shall not, 
however, restrict the right ef- the company to the 
insurer, at its own expense, to periodically ex- 
amine or cause to have examined the insured ac- 
cording to the terms of the contract of insurance. 



Statutory Authority 
58-65-1. 



G.S. 58-2-40; 58-51-1; 



.0323 COMPLICATION OF PREGNANCY 

Complications of pregnancy may not be treated 
differently from any other illness or sickness un- 
der the contract. A non-elective cesarean section 
is considered a complication of pregnancy. 

Statutory Authority G.S. 58-2-40; 58-3-120; 
58-51-1: 58-51-95; 58-63-15(7). 

.0325 WORKERS' COMPENSATION 

Benefits for occupational injury or sickness shall 
be provided when the insured is ineligible for 
workers' compensation benefits. 

Statutory Authority G.S. 58-2-40: 58-51-1; 
58-51-95. 

.0326 APPLICATION FOR INSURANCE 
REQUIRED 

Written applications for life, annuity and acci- 
dent and health insurance must be taken from 
North Carolina residents applying for such in- 
surance and, except in the case of direct response 
business, said application must be signed by a li- 
censed agent for this state. The signature of the 
licensed agent must be his actual signature. 

Statutory Authority G.S. 58-2-40; 58-33-25. 

SECTION .0400 - LIFE: GENERAL NATURE 

.0402 FAMILY LIFE POLICIES AND 
DEPENDENT TERM RIDERS 
(REPEALED) 

Statutory Authority G.S. 58-195. 

.0414 GROUP LIFE: STATE EMPLOYEES: 



6.S NORTH CAROLINA REGISTER July 15, 1991 



432 



PROPOSED RULES 



OTHER POLITICAL SUBDIVISION 
(REPEALED) 

Statutory Authority G.S. 58-210(6). 

.0420 APPROVAL OF CONTRACTS: 
ADDITIONAL INFORMATION 
REQUIRED 

A company submitting variable annuity con- 
tracts to the Department for approval shall fur- 
nish the following information with each variable 
annuity contract filing: 

( 1 ) evidence that a copy of all appropriate in- 
formation has been registered with the Se- 
curities and Exchange Commission, 

(2) a copy of all sales promotion material to 
be used in North Carolina, 

(3) a copy of the variable annuity application 
form. 

(4) a copy of the "Suitability Questionnaire" 
form. aft4 This shall be a form, either a 
separate form or a part of the application, 
containing questions designed to determine 
whether the proposed variable annuity con- 
tract meets the reasonable objectives and 
needs of the applicant. 

(5) a copy of all proposed riders to be used with 
the variable annuity contract. 

Statutory Authority G.S. 58-2-40; 58-~-95. 

.0426 LIFE INSURANCE ADVERTISING: 
FORM AND CONTENT 

(a) Advertisements shall be truthful and not 
misleading in fact or by implication. The form 
and content of an advertisement of a policy shall 
be sufficiently complete and clear so as to avoid 
deception. It shall not have the capacity or 
tendency to mislead or deceive. 

Whether an advertisement has the capacity or 
tendency to mislead or deceive shall be deter- 
mined by the Commissioner of Insurance from 
the overall impression that the advertisement 
may be reasonably expected to create upon a 
person of average education or intelligence within 
the segment of the public to which it is directed. 

(b) No advertisement shall use the terms "in- 
vestment," "investment plan," "founder s plan," 
"charter plan," "estate? accumulation p e riod." 
"certificate of deposit." "expansion plan," "pro- 
fit," "profits," "profit sharing," "interest plan," 
"savings." "savings plan" or other similar terms 
in connection with a policy in a context or under 
such circumstances or conditions as to have the 
capacity or tendency to mislead a purchaser or 
prospective purchaser of such policy to believe 
that he will receive, or that it is possible that he 
will receive, something other than a policy or 



some benefit not available to other persons of the 
same class and equal expectation of life. 

Statutory Authority G.S. 58-2-40; 58-58-40. 

.0427 LIFE INSURANCE ADVERTISING: 
DISCLOSURE REQUIREMENTS 

(a) The information required to be disclosed 
by 11 NCAC 12 .0424 to .0433 shall not be 
minimized, rendered obscure or presented in an 
ambiguous fashion or intermingled with the text 
of the advertisement so as to be confusing or 
misleading. 

(b) No advertisement shall omit material in- 
formation or use words or phrases in other than 
their customary insurance meaning or use words, 
phrases, statements, references or illustrations if 
such omission or such use has the capacity, 
tendency, or effect of misleading or deceiving 
purchasers or prospective purchasers as to the 
nature or extent of any policy benefit payable, 
loss covered, premium payable or state or federal 
tax consequences. The fact that the policy of- 
fered is made available to a prospective insured 
for inspection prior to consummation of the sale, 
or an offer is made to refund the premium if the 
purchaser is not satisfied, does not remedy mis- 
leading statements. 

(c) In the event an advertisement uses "Non- 
Medical", "No Medical Examination Required" 
or similar terms where issue is not guaranteed, 
such terms shall be accompanied by a further 
disclosure of equal prominence and in 
juxtaposition thereto to the effect that issuance 
of the policy may depend upon the answers to 
the health questions. 

(d) .An advertisement shall not use as the name 
or title of a fife insurance policy any phrase which 
does not include the words "fife insurance" un- 
less accompanied by other language clearly indi- 
cating it is life insurance. 

(e) An advertisement shall prominently de- 
scribe the type of policy advertised. 

(f) An advertisement of a policy marketed by 
the direct response techniques shall not state or 
imply that because there is no agent or commis- 
sion involved there will be cost saving to pro- 
spective purchasers unless such is the fact. 

(g) .An advertisement for a policy containing 
graded or modified benefits shall prominently 
display any limitation of benefits. If the pre- 
mium is level and coverage decreases or increases 
with age or duration, such fact shall be promi- 
nently disclosed. 

(h) An advertisement for a policy with non- 
level premiums shall prominently describe the 
premium changes. 

(i) Noneuaranteed Policy Elements: 



433 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



(1) An advertisement shall not utilize or de- 
scribe nonguaranteed policy elements in a 
manner which is misleading or has the 
capacity or the tendency to mislead. 

(2) An advertisement shall not state or imply 
that the payment or amount of nonguar- 
anteed policy elements is guaranteed. If 
nonguaranteed policy elements are illus- 
trated, they must be based on the insurer's 
current scale and the illustration must 
contain a statement to the effect that they 
are not to be construed as guarantees or 
estimates of amounts to be paid in the 
future. 

(3) An advertisement that includes any illus- 
trations or statements containing or based 
upon nonguaranteed elements shall set 
forth with equal prominence comparable 
illustrations or statements containing or 
based upon the guaranteed element. 

(4) If an advertisement refers to any non- 
guaranteed policy element, it shall indicate 
that the insurer reserves the right to 
change any such element at any time and 
for any reason. However, if an insurer has 
agreed to limit this right in any way, such 
as, for example, if it has agreed to change 
these elements only at certain intervals or 
only if there is a change in the insurer's 
current or anticipated experience, the ad- 
vertisement may indicate any such limita- 
tion of the insurer's right. 

(5) An advertisement shall not refer to divi- 
dends as "tax free"use words of similar 
import, unless the tax treatment of divi- 
dends is fully explained and the nature of 
the dividend as a return of premium is in- 
dicated clearly. 

(j) An advertisement shall not state that a pur- 
chaser of a policy will share in or receive a stated 
percentage or portion of the earnings on the 
general account assets of the company. 

(k) Testimonials or Endorsements by Third 
Parties: 

(1) Testimonials used in advertisements must 
be genuine; represent the current opinion 
of the author; be applicable to the policy 
advertised, if any; and be accurately re- 
produced. In using a testimonial, the 
insurer makes as its own all of the state- 
ments contained therein, and such state- 
ments are subject to all provisions of 1 1 
NCAC 12 .0424 to .0433. 

(2) If the individual making a testimonial or 
an endorsement has a financial interest in 
the insurer or a related entity as a stock- 
holder, director, officer, employee or oth- 
erwise, or receives any benefit directly or 



indirectly other than required union scale 
wages, such fact shall be disclosed in the 
advertisement. 
(3) An advertisement shall not state or imply 
that an insurer or a policy has been ap- 
proved or endorsed by a group of indi- 
viduals, society, association or other 
organization unless such is the fact and 
unless any proprietary relationship be- 
tween an organization and the insurer is 
disclosed. If the entity making the 
endorsement or testimonial is owned, 
controlled or managed by the insurer, or 
receives any payment or other consider- 
ation from the insurer for making such 
endorsement or testimonial, such fact 
shall be disclosed in the advertisement. 
(1) An advertisement shall not contain statis- 
tical information relating to any insurer or policy 
unless it accurately reflects recent and relevant 
facts. The source of any such statistics used in 
an advertisement shall be identified therein. 

(m) Introductory, Initial or Special Offers and 
Enrollment Periods: 

(1) An advertisement of an individual policy 
or combination of' such policies shall not 
state or imply that such policy or combi- 
nation of such policies is an introductory, 
initial or special offer, or that applicants 
will receive substantial advantages not 
available at a later date, or that the offer 
is available only to a specified group of 
individuals, unless such is the fact. An 
advertisement shall not describe an en- 
rollment period as "special" or "limited" 
or use similar words or phrases in de- 
scribing it when the insurer uses successive 
enrollment periods as its usual method of 
marketing of its policies. 

(2) An advertisement shall not state or imply 
that only a specific number of policies will 
be sold, or that a time is fixed for the dis- 
continuance of the sale of the particular 
policy advertised because of special ad- 
vantages available in the policy. 

(3) An advertisement shall not offer a policy 
which utilizes a reduced initial premium 
rate in a manner which overemphasizes 
the availability and the amount of the re- 
duced initial premium. When an insurer 
charges an initial premium that differs in 
amount from the amount of the renewal 
premium payable on the same mode, all 
references to the reduced initial premium 
shall be followed by an asterisk or other 
appropriate symbol which refers the 
reader to that specific portion of the ad- 



6:8 NORTH CAROLINA REGISTER July 15, 1 99 1 



434 



PROPOSED RULES 



vcrtisement which contains the full rate 
schedule for the policy being advertised. 
(4) An enrollment period during which a 
particular insurance policy may be pur- 
chased on an individual basis shall not be 
offered within this state unless there has 
been a lapse of not less than three months 
between the close of the immediately pre- 
ceding enrollment period for the same 
policy and the opening of the new enroll- 
ment period with the number of enroll- 
ment periods being limited to no more 
than two in any one calendar year for a 
particular insurance product. The adver- 
tisement shall specify the date by which 
the applicant must mail the application, 
which shall not be later than 10 days and 
not more than 40 days on which such en- 
rollment period is advertised for the first 
time. This shall apply to all advertising 
media--i.e., mail, newspapers, radio, tele- 
vision, magazines and periodicals—by any 
one insurer. The phrase "any one 
insurer" includes all the affiliated compa- 
nies of a group of insurance companies 
under common management or control. 
This does not apply to the use of a ter- 
mination of cutoff date beyond which an 
individual application for a guaranteed is- 
sue policy will not be accepted by an 
insurer in those instances where the ap- 
plication has been sent to the applicant in 
response to his request. It is also inap- 
plicable to solicitations of employees or 
members of a particular group or associ- 
ation which otherwise would be eligible 
under specific provisions of the insurance 
code for group insurance. In cases where 
an insurance product is marketed on a di- 
rect mail basis to prospective insureds by 
reason of some common relationship with 
a sponsoring organization, this shall be 
applied separately to each such sponsoring 
organization. 
(n) An advertisement of a particular policy 
shall not state or imply that prospective insureds 
shall be or become members of a special class, 
group or quasi-group and as such enjoy special 
rates, dividends or underwriting privileges unless 
such is the fact. 

(o) An advertisement shall not make unfair or 
incomplete comparisons of policies, benefits, 
dividends or rates of other insurers. An adver- 
tisement shall not falsely or unfairly describe 
other insurers, their policies, services or methods 
of marketing. 

(p) It shall be unlawful to make use directly 
or indirectly, of any method of marketing which 



fails to disclose in a conspicuous manner that a 
purpose of the method of marketing is solicita- 
tion of insurance and that contact will be made 
by an insurance agent or insurance agency. 

Statutory Authority G.S. 58-2-40; 58-58-40; 
58-63-15. 

.0431 LIFE INSURANCE ADVERTISING: 
ENFORCEMENT PROCEDURES 

(a) Each insurer shall maintain at its home or 
principal office a complete fde containing a 
specimen copy of every printed, published or 
prepared advertisement of its group policies, 
hereafter disseminated in this state, with a nota- 
tion indicating the manner and extent of distrib- 
ution and the form number of any policy 
advertised. Such fde shall be subject to in- 
spection by this department. All such advertise- 
ments shall be maintained in said fde for a period 
of either fow three years or until the fding of the 
next regular report on examination of the insurer, 
whichever is the longer period of time. 

(b) Each insurer subject to the provisions of 
11 NCAC 12 .0424 to .0433 shall fde with this 
department with its annual statement a certificate 
of compliance executed by an authorized officer 
of the insurer wherein it is stated that to the best 
of his knowledge, information and belief the ad- 
vertisements which were disseminated by or on 
behalf of the insurer in this state during the pre- 
ceding statement year, or during the portion of 
such year when 1 1 NCAC 12 .0424 to .0433 were 
in effect, complied or were made to comply in 
all respects with the provisions of 11 NCAC 12 
.0425 to .0433 and the insurance laws of this state 
as implemented and interpreted bv 11 NCAC 12 
.0424 to .0433. 

(c) Advertisements written bv agents, which 
describe a policy in any manner, must be sub- 
mitted to the home office of the insurance com- 



pany offering the policy for its approval before 
use bv the agent. Each agent shall maintain a 
record of all such advertisements and home office 



appro' 



als for at least three years. 



Statutory Authority G.S. 58-2-40; 
58-63-15. 



58-58-40; 



.0434 VARIABLE LIFE INSURANCE 
DEFINITIONS 

As used in this Regulation: 

(1) "Affiliate" of an insurer means any person, 
directly or indirectly, controlling, controlled 
by, or under common control with such 
insurer; any person who regularly furnishes 
investment advice to such insurer with re- 
spect to its variable life insurance separate 



435 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



accounts for which a specific fee or com- 
mission is charged; or any director, officer, 
partner, or employee of any such insurer, 
controlled person, or person providing in- 
vestment advice or any member of the im- 
mediate family of such person. 

(2) "Agent" means any person, corporation, 
partnership, or other legal entity which is li- 
censed by this state as a life insurance agent. 

(3) "Assumed investment rate" means the rate 
of investment return which would be re- 
quired to be credited to a variable life insur- 
ance policy, after deduction of charges for 
taxes, investment expenses and mortality 
and expense guarantees to maintain the var- 
iable death benefit equal at all times to the 
amount of death benefit, other than inci- 
dental insurance benefits, which would be 
payable under the plan of insurance if the 
death benefit did not vary according to the 
investment experience of the separate ac- 
count. 

(4) "Benefit base" means the amount not less 
than the amount specified under .0438(b)(2) 
of this Section, specified by the terms of the 
variable life insurance policy to which the 
difference between the net investment return 
and the assumed investment rate is applied 
in determining the variable benefits of the 
policy. 

(5) "Commissioner" means the Insurance 
Commissioner of this state. 

(6) "Control" (including the terms "control- 
ling," "controlled by" and "under common 
control with") means the possession, direct 
or indirect, of the power to direct or cause 
the direction of the management and policies 
of a person, whether through the ownership 
of voting securities, by contract other than 
a commercial contract for goods or non- 
management services, or otherwise, unless 
the power is the result of an official position 
with or corporate otfice held by the person. 
Control shall be presumed to exist if any 
person, directly or indirectly, owns, controls, 
holds with the power to vote, or holds 
proxies representing more than 10 percent 
of the voting securities of any other person. 
This presumption may be rebutted by a 
showing made to the satisfaction of the 
commissioner that control does not exist in 
fact. The commissioner may determine, af- 
ter furnishing all persons in interest notice 
and opportunity to be heard and making 
specific findings of fact to support such de- 
termination, that control exists in fact, 
notwithstanding the absence of a 
presumption to that effect. 



(7) "General account" means all assets of the 
insurer other than assets in separate ac- 
counts established pursuant to G.S. 58-79.2 
of the insurance laws of this state, or pursu- 
ant to the corresponding section of the in- 
surance laws of the state of domicile of a 
foreign or alien insurer, whether or not for 
variable life insurance. 

(8) "Incidental insurance benefit" means all 
insurance benefits in a variable life insurance 
policy, other than the variable death benefit 
and the minimum death benefit, including 
but not limited to accidental death and 
dismemberment benefits, disability income 
benefits, guaranteed insurability options, 
family income, or fixed benefit term riders. 

(9) "May" is permissive. 

(10) "Minimum death benefit" means the 
amount of the guaranteed death benefit, 
other than incidental insurance benefits, 
payable under a variable life insurance policy 
regardless of the investment performance of 
the separate account. 

(11) "Net investment return" means the rate 
of investment return in a separate account 
to be applied to the benefit base after de- 
duction of charges for taxes, investment ex- 
penses and mortality and expense guarantees 
in accordance with the terms of the policy. 

(12) "Person" means an individual, corpo- 
ration, partnership, association, trust, or 
fund. 

(13) "Separate account" means a separate ac- 
count established for variable life insurance 
pursuant to G.S. 58-79.2 of the insurance 
laws of this state or pursuant to the corre- 
sponding section of the insurance laws of the 
state of domicile of a foreign or alien insurer. 

(14) "Shall" is mandatory. 

(15) "Variable death benefit" means the 
amount of the death benefit, other than in- 
cidental insurance benefits, payable under 
variable life insurance policy dependent on 
the investment performance of the separate 
account, which the insurer would have to 
pay in the absence of the minimum death 
benefit. 

(16) "Variable life insurance policy" means any 
individual or group policy which provides 
for life insurance the amount or duration of 
which varies according to the investment 
experience of any separate account or ac- 
counts established and maintained by the 
insurer as to such policy, pursuant to G.S. 
58-79.2 of the insurance laws of this state or 
pursuant to the corresponding section of the 
insurance laws of the state of domicile of a 
foreign or alien insurer. 



6:8 NORTH CAROLINA REGISTER July 15, 199 1 



436 



PROPOSED RULES 



Statutory Authority G.S. 58-2-40; 58-7-95. 

.0447 FREE LOOK PROVISION 

An insurer, prior to the time that any individual 
life insurance or annuity policy is issued for de- 
livery or delivered, shall ensure that a provision 
is displayed by sticker or printed on the face of 
each life insurance or annuity policy, containing 
the following as appropriate: 

( 1 ) if there is replacement of existing life insur- 
ance by an insurer not utilizing an agent in 
the sale or delivery of its policies, a "Thirty 
Day Free Look" provision; 

(2) in all other cases, a "Ten Day Free Look". 
The free look provision shall afford the 
policyholder a period of time, following re- 
ceipt of the policy, during which the policy 
may be returned to the company for a 
prompt refund of the premium paid. The 
same applies to any group life insurance or 
annuity policy or certificate which contains 
a free look provision. 

Statutory Authority G.S. 58-2-40; 58-58-1. 

.0448 WAITING PERIODS ON LIFE 
INSLRANCE RIDERS 

On all life insurance riders providing additional 
benefits, attached subsequent to the date of the 
policy, a sticker shall be attached in a prominent 
place on the rider stating, when appropriate, 
substantially the following: "PLEASE READ 
THIS RIDER CAREFULLY". 

THE WAITING PERIODS IN" THE SUI- 
CIDE AND/OR INCONTESTABILITY 
PROVISIONS ARE DIFFERENT FROM 
THOSE IN THE POLICY AND BEGIN ON 
THE EFFECTIVE DATE OF THE RIDER. 

Statutory Authority G.S. 58-2-40; 58-58-J. 

.0458 INTEREST CHARGES ON 
REINSTATEMENT 

The interest chargeable on delinquent premiums 
under a life or annuity policy reinstatement pro- 
vision shall not exceed the prevailing fixed, max- 
imum interest chargeable on life insurance policy 
loans. 

Statutory Authority G.S. 58-2-40; 58-58-1. 

.0459 SUICIDE AND/OR 

INCONTESTABILITY 

Waiting periods in the suicide and or 
incontestability provisions of life and annuity 
policies may not exceed two years from the pol- 
icy effective date. 



Statutory Authority G.S. 58-2-40; 58-58-1. 

.0460 PREARRANGEMENT INSLRANCE 
DISCLOSURE 

The amount of prearrangement insurance policy 
proceeds payable to the provider of a funeral 
service under a prearrangement contract shall not 
exceed the lesser of the total cost of the funeral 
service or the policy proceeds. 



Statutory 
58-60-35. 



Authority G.S. 58-2-40; 58-58-1; 



SECTION .0500 - ACCIDENT AND HEALTH: 
GENERAL NATURE 

.0504 APPROVAL OF FILING: 90 DAY 

DEEMER NOT IN EFFECT (REPEALED) 

Statutory Authority G.S. 58-254.7; 58-370(a). 

.0507 FRATERNAL ORDERS: SOCIETIES 
AND ASSOCIATIONS 

To the extent there is no conflict with the pro- 
visions of Article 24 or 25 of General Statute 
Chapter 58, every fraternal order, society or as- 
sociation writing accident and health insurance 
in this state must comply with the provisions of 
Articles 34 54^ & a«4 33A 50, 51 and 52 of 
Chapter 58 regarding accident and health insur- 
ance. 

Statutory Authority G.S. 58-2-45. 

.0514 COORDINATION: GROLP A/H 
CONTRACT BENEFITS: GROLP 
COVERAGES 

Purpose. In order to promote consistency in 
liability for claims and claims determination for 
Group Accident and Health coverage, the de- 
partment shall require a uniform order of benefits 
determination as follows: 

(1) Applicability: 

(a) This Coordination of Benefits ("COB") 
provision applies to this plan when a em- 
ployee or the employee's covered depend- 
ent has health care coverage under more 
than one plan. "Plan" and "This Plan" 
are defined in (2)(a) and (b) of this Rule. 

(b) If this COB provision applies, the order 
of benefit determination rules should be 
looked at first. Those rules determine 
whether the benefits of this plan are de- 
termined before or after those of another 
plan. The benefits of this plan: 

(i) Shall not be reduced when, under the 
order of benefit determination rules, this 
plan determines its benefits before another 
plan; but 



437 



6:8 NORTH CAROLINA REGISTER July 15, 1 99 1 



PROPOSED RULES 



(ii) May be reduced when, under the order 
of benefit determination rules, another 
plan determines its Section (IV) Effect on 
the Benefits of this plan. 
(2) Definitions: 

(a) A "Plan" is any of these which provides 
benefits or services for, or because of, 
medical or dental care or treatment: 

(i) True group insurance, whothor insured 
©f Dolf insured. This includes prepay- 
ment, group practice or individual practice 
coverage. It does not include school 
accident-type coverage, blanket, franchise 
individual, automobile and homeowner 
coverage, 
(ii) Coverage under a governmental plan 
or required or provided by law. This does 
not include a state plan under Medicaid 
(Title XIX, Grants to States for Medical 
Assistance Programs, of the United States 
Social Security Act as amended from time 
to time). It also does not include any plan 
when, by law, its benefits are excess to 
those of any private insurance program 
or other non-governmental program. 
Each contract or other arrangement for cover- 
age under (2)(a) (i) or (ii) is a separate plan. 
Also, if an arrangement has two parts and COB 
rules apply only to one of the two, each of the 
parts is a separate plan. 

(b) "This Plan" is the part of the group con- 
tact that provides benefits for health care 
expenses. 

(c) "Primary Plan"/ "Secondary Plan". The 
order of benefit determination rules state 
whether this plan is a Primary Plan or 
Secondary Plan as to another plan cover- 
ing the person. When this plan is a Pri- 
mary Plan, its benefits are determined 
before those of the other plan and without 
considering the other plan's benefits. 
When there are more than two plans 
covering the person, this plan may be a 
Primary Plan as to one or more other 
plans, and may be a Secondary Plan as to 
a different plan or plans. 

(d) "Allowable Expense" means a necessary, 
reasonable, and customary item of ex- 
pense for health care, when the item of 
expense is covered at least in part by one 
or more plans covering the person for 
whom the claim is made. When a plan 
provides benefits in the form of services, 
the reasonable cash value of each service 
rendered will be considered both an al- 
lowable expense and a benefit paid. Total 
benefits paid must be equal 100 percent 



of necessary medical expenses covered by 
both plans. 
(e) "Claim Determination Period" means a 
calendar year. However, it does not in- 
clude any part of a year during which a 
person has no coverage under this plan, 
or any part of a year before the date this 
COB provision or a similar provision 
takes effect. 
(3) Order of Benefit Determination Rules: 

(a) General. When there is a basis for a claim 
under this plan and another plan, this plan 
is a Secondary Plan which has its benefits 
determined after those of the other plan, 
unless: 

(i) the other plan has rules coordinating its 
benefits with those of this plan; and 

(ii) both those rules and this plan's rules, in 
(3)(b)(ii)(B) of this Rule, require that this 
plan's benefits be determined before those 
of the other Plan. 

(b) Rules. This plan determines its order of 
benefits using the first of the following 
rules which applies: 

(i) Non-dependent/ Dependent. The bene- 
fits of the plan which covers the person 
as an employee, member or subscriber 
(that is, other than as a dependent) are 
determined before those of the plan which 
covers the person as a dependent. 

(ii) Dependent Child/ Parents Not Sepa- 
rated or Divorced. Except as stated in 
(3)(b)(iii)(B) of this Rule, when this plan 
and another plan cover the same child as 
a dependent of different persons, called 
"parents": 

(A) the benefits of the plan of the parent 
whose birthday falls earlier in a year are 
determined before those of the plan of 
the parent whose birthday falls later in 
that year; but 

(B) if both parents have the same birth- 
day, the benefits of the plan that has 
covered a parent for a longer period of 
time are determined before those of the 
plan that covered the other parent for a 
shorter period of time. 

However, if the other plan does not have the 
rule described in Paragraph (3)(a) in this Rule, 
but instead has a rule based upon the gender of 
the parent, and if, as a result, the plans do not 
agree on the order of benefits, the rule in the 
other plan will determine the order of benefits, 
(iii) Dependent Child Separated or Di- 
vorced Parents. If two or more plans 
cover a person as a dependent child of di- 
vorced or separated parents, benefits for 
the child are determined in this order: 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



438 



PROPOSED RULES 



(A) first, the plan of the parent with 
custody of the child; 

(B) then, the plan of the spouse of the 
parent with custody of the child; and 

(C) finally, the plan of the parent not 
having custody of the child. 

However, if the specific terms of a court decree 
state that one of the parents is responsible for the 
health pay or provide the benefits of the plan of 
that parent has actual knowledge of those terms, 
the benefits of that plan are determined first. In 
this Rule, (3)(b)(iii)(C) does not apply with re- 
spect to any claim determination period or plan 
year during which any benefits are actually paid 
or provided before the entity has that actual 
knowledge. 

(iv) Active Inactive Employee. The bene- 
fits of a plan which covers a person as an 
employee who is neither laid off nor re- 
tired (or as that employee's dependent) are 
determined before those of a plan which 
covers that person as a laid off or retired 
employee (or as that employee's depend- 
ent). If the other plan does not have 
(3)(b)(iv), and if, as a result, the plans do 
not agree on the order of benefits, 
(3)(b)(iv) is ignored, 
(v) Longer/Shorter Length of Coverage. If 
more of Paragraph (3) of this Rule deter- 
mines the order of benefits, the benefits 
of the plan which covered an employee, 
member or subscriber longer are deter- 
mined before those of the plan which 
covered that person for the shorter time. 

Statutory Authority G.S. 58-2-45; 58-51-1; 
58-65-1; 58-65-40. ' 

.0517 ACCIDENT AND HEALTH 

ADVERTISING: DEFINITIONS 

The following definitions are applicable to acci- 
dent and health advertising Rules 1 1 NCAC 1 2 
.0516 to .0536 only: 

(1) "Advertisement" is defined as: 

(a) printed and published material, audio vis- 
ual material, and descriptive literature of 
an insurer used in direct mail, newspapers, 
magazines, radio scripts, TV scripts, 
billboards and similar displays; and 

(b) descriptive literature and sales aids of all 
kinds issued by an insurer, agent or broker 
for presentation to members of the insur- 
ance buying public, including but not 
limited to circulars, leaflets, booklets, de- 
pictions, illustrations, and form letters; 
and 



(c) prepared sales talks, presentations and 
material for use by agents, brokers and 
solicitors. 

(2) "Policy" is defined as any policy, plan, 
certificate, contract, agreement, statement of 
coverage, rider or endorsement which pro- 
vides long term care, medicare supplement, 
accident or sickness benefits or medical, 
surgical or hospital expense benefits, 
whether on an indemnity, reimbursement, 
service or prepaid basis, except when issued 
in connection with another kind of insur- 
ance other than life and except disability, 
waiver of premium and double indemnity 
benefits included in life insurance and annu- 
ity contracts. 

(3) "Insurer" is defmed as any individual, cor- 
poration, association, partnership, reciprocal 
exchange, inter-insurer, Lloyd's, fraternal 
benefit society, health maintenance organ- 
ization, and any other legal entity which is 
defined as an "insurer" in the insurance code 
of this state and is engaged in the advertise- 
ment of a policy as "policy" is herein de- 
fined. 

(4) "Exception" is defmed as any provision in 
a policy whereby coverage for a specified 
hazard is entirely eliminated; it is a statement 
of a risk not assumed under the policy. 

(5) "Reduction" is defined as any provision 
which reduces the amount of the benefit; a 
risk of loss is assumed but payment upon 
the occurrence of such loss is limited to 
some amount or period less than would be 
otherwise payable had such reduction not 
been used. 

(6) "Limitation" is defined as any provision 
which restricts coverage under the policy 
other than an exception or a reduction. 

(7) "Institutional advertisement" is defmed as 
an advertisement having as its sole purpose 
the promotion of the reader's or viewer's 
interest in the concept of accident and sick- 
ness insurance, or the promotion of the 
insurer. 

(8) "Invitation to inquire" is defmed as adver- 
tisement having as its objective the creation 
of a desire to inquire further about the 
product and which is limited to a brief de- 
scription of the loss for which the benefit is 
payable, and which may contain: 

(a) the dollar amount of benefits payable; and 

(b) the period of time during which the bene- 
fits are payable; provided the advertise- 
ment does not refer to cost; An 
advertisement which specified either the 
dollar amount of benefit payable or the 
period of time during which the benefit is 



439 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



(9) 



payable shall contain a provision in effect 
as follows: 

"For costs and further details of the cov- 
erage, including exclusions, any reductions 
or limitations and terms under which the 
policy may be continued in force, see your 
agent or write to the company." 
"Invitation to contract" is denned as an 
advertisement which is neither an invitation 
to inquire nor an institutional advertisement. 



Statutory Authority G.S. 58-2-40; 58-63-15; 
58-65-1; 58-65-40; 58-67-1; 58-67-/50. 

.0526 ACCIDENT AND HEALTH 

ADVERTISING OF PLAN OR 
POLICIES 

When a choice of the amount of benefits is re- 
ferred to, an advertisement which is an invitation 
to contract shall disclose that the amount of 
benefits provided depends upon the plan selected 
and that the premium will vary with the amount 
of the benefits selected. 

When an advertisement which is a» invitation 
to contract refers to various benefits which may 
be contained in two or more policies, other" than 
group master policies, the advertisement shall 
disclose that such benefits are provided only 
through a combination of such policies. 

Statutory Authority G.S. 58-2-45; 58-63-/5. 

.0527 ACCIDENT AND HEALTH 

ADVERTISING: COMPARISONS: 
STATEMENTS (REPEALED) 

Statutory Authority G.S. 58-9(1); 58-54.4. 

.0537 PRE-EXISTING CONDITIONS: 

INSURED'S AGE OYER 65 (REPEALED) 

Statutory Authority G.S. 58-251.1; 58-252. 

.0553 EXCESS INSURANCE: 

NON-DUPLICATION OF COVERAGE 

(a) An A and H policy with a nonduplication 
of coverage benefit may be permitted, if it con- 
tains the following sticker on the face in red: 

EXCESS INSURANCE 
This policy is not intended to be issued where 
other medical insurance exists. If other medical 
insurance does exist at the time of the claim, then 
the amounts of benefit payable by such other 
medical insurance will become the deductible 
amount of this policy if such benefits exceed the 
deductible amount shown in the Schedule of 
Benefits. 

Such sticker shall be in red bold face type the size 
of which shall not be less than 14 points. The 



use of a rubber stamp will not satisfy this re- 
quirement. 
(b) Non-duplication of coverage benefit in 
Blanket Insurance shall be permitted when pre- 
miums are non-contributory and 100 percent of 
the participants are covered. 



Statutory Authority 
58-65-1; 58-65-40. 



G.S. 58-2-35; 58-51-1; 



.0554 STOP-LOSS COVERAGE - 

REQUIREMENTS (REPEALED) 

Statutory Authority G.S. 58-9; 58-249; 58-254.7. 

.0555 LONG TERM CARE INS - REQMNTS: 

LONG TERM CARE POLICY REQMNTS 

(a) Definitions: 

(1) Long-Term Care Insurance is defined as 
any contract of insurance offering institu- 
tional or noninstitutional support in order 
to resore deteriorating health and to 
maintain functional independence. Such 
services for an acute or chronic physical 
or mental impairment, or short term ill- 
ness or injury, include but are not limited 
to assistance with daily living, medical or 
rehabilitative care, and home health care. 

(2) In regard to Skilled, Intermediate, Custo- 
dial, or Home Health Care, when the in- 
sured receives definitive treatment for 
these services regardless of the type of fa- 
cility or setting the insured is confined in, 
benefits are payable for the service receive 
based on the benefits of the contract for 
that service. 

(3) Custodial or Domiciliary Home facilities 
will be considered the same for insurance 
purposes. 

(b) The following provisions are required: 

(-44 Prior r . ldllod nursing homo confinement 
f»ay r+»4- be required to satisfy eligibility 
fof benefits m lower levels ef caro. 

(-2} Prior hospitalization may net- be required 
to- satisfy eligibility fef long term eafe 
benefits. 

(1) (4+ Long-term care insurance policies must 

provide benefits for at least three levels of 
care and provide the same duration for 
each level of care for a minimum of 12 
months. 

(2) (4) Coordination or non-duplication of 
benefits is permitted between true group 
long-term care policies only. 

(3) (4) The loss ratio is required to be at least 

60 percent for individual policies and at 
least 75 percent for group policies. 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



440 



PROPOSED RULES 



(& 



(41 



yekss th* solvency ef tfe* insur e r h at- ask 
»H individual Long Term Car e policies 
must be guaranteed F&aewaMfe 
Custodial care which is administered for 



lows: Important Cancellation Information - 
Please Read The Provision Entitled, 

" ", Found On Page "...". 

(b) Laser printed policies may be excused from 

this red print requirement provided the notice is 

in bold lace print. Companies certify that policy 

forms are produced by laser print in order to ex^ 

d lm but rather must be provided as ercise this excuse. 



assistance of the patient in performing the 
activities of daily living cannot be denied 
based on the type of facility care is re- 



long as the insured is confined as an in- 
patient in anv facility licensed bv the state 
regardless of whether or not that facility 
is commonly understood to be or is de- 
fined as a lone-term care facility. 



Statutory Authority G.S. 58-2-40; 58-51-1. 
.0558 PREMIUM REVISION (REPEALED) 



(5) The definition of facilities must include Statutory Authority G.S. 58-9; 58-249; 58-254.7. 



language that facility or setting complies 
with the North Carolina Licensure Facil- 
ity Act. Chapter 131D and Chapter L31E. 
(6) No long-term care policy, contract, or 
certificate may use waivers to exclude, 
limit or reduce benefits for specifically 
named or described pre-existing diseases 
or physical conditions. 

Statutory Authority G.S. 58-4-40; 58-51-1; 
58-51-95; 58-55-30. 

.0556 HOME HEALTH CARE POLICY 
REQUIREMENT 

All Home Health Care Policies shall have the 
notice printed in contrasting type or color on the 
face of the policy as follows: "This Is Not A 
Long-Term Care Policy - This Policy Provides 
Home Health Care Benefits Only - Read Care- 
fully". Home health care policies must comply 
with Gr&r 58 252. G.S. 5S-5 1-611 and the fol- 
lowing items: 

( 1 1 Prior hospitalization or skilled nursing 
home confinement may not be required to 
satisfy eligibility for benefits. 

(2) Benefits shall be provided without a physi- 
cian certification that the insured or claimant 
would need medical care m a skilled nursing 
facility or hospital setting. 

(3) I lome health benefits cannot be limited to 
acute conditions. 



Statutory Authority G.S. 58-2-40; 58-51-1; 
58-51-95. 

.0557 POLICIES CONTAINING A 

TERMINATION OR CANCELLATION 
PROVISION 

(a) Any policy or certificate of insurance which 
may be terminated for reasons other than non- 
payment of premium or the insured's stated age 
must be affixed with a notice referring the insured 
to the renewal provision. Such notice must ap- 
pear in 14 point bold red print and read as fol- 



.0559 PRECERTIEICATION 

Policies requiring precertification must contain 
a disclosure of penalties for benefits and services 
that are not precertified. 

Statutory Authority G.S. 58-50-60. 

SECTION .1 100 - MORTGAGE 
CONSOLIDATION 

.1101 APPLICATION 

These Rules apply to: 

(1) All consolidations, whether the old cover- 
age is provided under an individual or a 
group policy; and 

(2) All mortgage insurance offered, issued, or 
delivered in this state, through the mail or 
otherwise, in connection with consol- 
idations. 

Statutory Authority G.S. 58-2-40; 58-2-2/0. 

.1102 DEFINITIONS 

In this Regulation, unless the context clearly 
indicates otherwise: 

(1) "Consolidation" means any transaction in 
which a financial institution or servicer 
makes its premium collection services avail- 
able to its mortgage debtors in connection 
with a particular insurer's ("new insurer") 
offer of mortgage insurance, which offer is 
made to debtors who, immediately prior to 
the offer, had mortgage insurance with an- 
other insurer ("old insurer") and were pay- 
ing premiums for that insurance with their 
monthly mortgage payments. 

(2) "Financial institution" or "servicer" means 
any entity or organization that services 
mortgage loans by collecting and accounting 
for monthly mortgage payments. 

(3) "Loan transfer" means a transaction in 
which the servicing of a block of mortgage 
loans is transferred from one servicer to an- 
other. This includes, but is not limited to. 



441 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



a transfer of servicing to a new servicing lo- 
cation which occurs within a financial insti- 
tution following, and as a result of, a merger 
or acquisition. 

(4) "Loan transfer consolidation" means a 
consolidation involving debtors whose 
mortgage loans have been transferred from 
one servicer to another. 

(5) "Mortgage" or "mortgage loan" means an 
indebtedness which is secured by real estate 
and which is not subject to N.C.G.S. 
Chapter 58, Article 57. 

(6) "Mortgage insurance" means group or in- 
dividual life, individual accidental death, or 
individual disability insurance, or any com- 
bination thereof, designed to pay all or part 
of a mortgage loan in the event of the 
insured's death or disability. 

(7) "New coverage" or "new plan" means the 
mortgage insurance coverage or mortgage 
insurance plan for which the financial insti- 
tution collects premiums beginning on the 
effective date of a consolidation. 

(8) "Old coverage" or "old plan" means the 
mortgage insurance coverage or mortgage 
insurance plan the financial institution col- 
lected premiums for immediately prior to the 
consolidation. 

Statutory' Authority G.S. 5S-2-40; 58-2-210. 

.1103 GENERAL REQUIREMENTS 

No insurer shall participate in any consolidation 
unless it complies with the following require- 
ments: 

(1) The offer of new coverage must be made 
on a timely basis: 

(a) In a loan transfer consolidation, the offer 
of new coverage to the prospective insured 
must be made as soon as reasonably pos- 
sible. If the offer of new coverage is not 
made at least 30 days prior to the pro- 
posed effective date of the new coverage, 
the insurer shall notify the debtor, in 
writing, that he has the right to an un- 
conditional refund of all premiums paid 
since the transfer date provided he exer- 
cises the right, in writing, within 30 days 
from the date of the notification. 

(b) In all other consolidations, the offer of 
new coverage shall be made to the pro- 
spective insured at least 30 days prior to 
the proposed effective date of the new 
coverage. 

(2) A group certificate or individual policy shall 
be delivered to each debtor insured under 
the new plan. In addition to all other re- 
quirements of N.C.G.S. Chapter 58 appli- 



cable thereto, the group certificate or 
individual policy shall include the following 
information: 

(a) The name or names of the single or joint 
insureds; 

(b) Identification of the insured mortgage; 

(c) The amount of insurance under the new 
plan; 

(d) The premium for the new coverage; 

(e) The effective date of the new coverage; and 
(fj The beneficiary for the new coverage. If 

the insured had the right to name a bene- 
ficiary under the old contract, the insured 
shall retain this right under the new con- 
tract. 

(3) No group certificate or individual policy 
evidencing the new coverage shall include a 
contestability clause or, in the case of mort- 
gage life insurance, a provision excluding 
suicide. 

(4) Notwithstanding the provisions of 
N.C.G.S. 58-58-140, all group mortgage life 
insurance certificates issued in connection 
with any consolidation shall include a con- 
version privilege permitting an insured 
debtor to convert, without evidence of 
insurability, to an individual policy of de- 
creasing term insurance within 30 days of the 
date the insured debtor's group coverage is 
terminated for reasons other than the non- 
payment of premiums. The initial amount 
of coverage under the individual policy shall 
be an amount equal to the amount of cov- 
erage terminated under the group policy and 
shall decrease over a term that corresponds 
with the scheduled term of the insured 
debtor's mortgage loan. The premium for 
the individual policy shall be the same pre- 
mium the insured debtor was paying under 
the group policy. 

(5) Except for offers of new coverage made 
pursuant to Rules .1104, .1105, and .1107 
of this Section, the new coverage shall be 
effectuated for the prospective insured only 
after the new insurer receives an application 
which has been signed by the prospective 
insured. 

(6) Except as provided in Rules .1104, .1105, 
and .1107 of this Section, the new insurer 
must calculate premiums for the new cover- 
age on the basis of its own rates, the pro- 
spective insured's then attained age, if 
applicable, and the amount of insurance of- 
fered. 

Statutory Authority G.S. 58-2-40; 58-2-210. 

.1104 LOAN TRANSFER CONSOLIDATIONS 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



442 



PROPOSED RULES 



(a) In a consolidation conducted as a result of 
a loan transfer, the offer of new coverage may be 
based on the same premium the prospective in- 
sured was paying for his old coverage, and a 
signed application need not be obtained, if the 
new insurer complies with all applicable require- 
ments of this Regulation and N.C.G.S. Chapter 
58, and the following conditions are met: 

(1) The old coverage is accidental death in- 
surance, disability insurance, or group 
mortgage life insurance. 

(2) The amount of insurance provided by the 
new plan must be the same or greater than 
provided by the old plan. 

(3) All of the benefits provided by the old 
plan, including but not limited to acci- 
dental death riders and waiver-of- 
premium benefits, must be provided by 
the new plan. 

(b) Individual policies of mortgage life insur- 
ance may not be consolidated pursuant to this 
Section. 

Statutory Authority G.S. 58-2-40; 5S-2-2/0. 

.1105 OTHER CONSOLIDATIONS 

In all other consolidations (excluding loan 
transfer consolidations) the offer of new coverage 
may be based on the same premium the pro- 
spective insured was paying for his old coverage, 
and a signed application need not be obtained, if 
the new insurer complies with all applicable re- 
quirements of this Regulation and N.C.G.S. 
Chapter 58, and the following conditions are met: 

(1) The old coverage is group mortgage life in- 
surance, accidental death insurance, or disa- 
bility insurance. 

(2) The amount of insurance provided by the 
new plan must be the same or greater than 
provided by the old plan. 

(3) All the benefits provided by the old plan, 
including but not limited to accidental death 
riders and waiver-of-premium benefits, must 
be provided by the new plan. 

(4) Individual policies of mortgage life insur- 
ance may not be consolidated pursuant to 
this Section. 

Statutory Authority G.S. 5S-2-40; 5S-2-2/0. 

.1106 DISCLOSURE REQUIREMENTS 

In conjunction with any offer of new coverage 

made in any consolidation, the new insurer shall 

disclose in writing to each debtor the following: 

( 1 ) That the insured may have the right to 

continue or convert his old coverage by 

paying premium directly to the old insurer; 



(2) That the new coverage is not conditioned 
upon either the termination or replacement 
of the old coverage; 

(3) The name and address of the old and new 
insurer; 

(4) The effective date of the new coverage; 

(5) The beneficiar>' of the new coverage; 

(6) Amount of coverage for both the new and 
old plans. If the amount of coverage for the 
old plan is not known, a statement that the 
amount may be scheduled and it may be less 
than or greater than the amount of the loan 
and the insured should check his old policy 
schedule for an exact amount of coverage; 

(7) Material differences, if any, between the 
new plan and the old plan; 

(8) A statement as to whether the old plan was 
an individual or group plan and a statement 
as to whether the new plan is an individual 
or a group policy. 

(9) Cautionary language shall be affixed in 
sticker form in bold type upon the face or 
insert page of any policy certificate issued 
under the new plan with language substan- 
tially as follows: 

IMPORTANT NOTICE 

This certificate policy is issued to you in 
connection with a mortgage insurance con- 
solidation. It is the intention of the insurer 
to provide you coverage that is equal to or 
better than the coverage you had before. 
To the extent the benefits provided or the 
provisions of your prior certificate policy are 
more liberal than those under this 
certificate policy, the provisions of your 
prior certificate will control. This 

policy, certificate shall be incontestable from 
its date of issue. 

Statutory Authority G.S. 58-2-40; 58-2-210. 

.1 107 DISABILITY INSURANCE PLANS 

If the financial institution sponsors a mortgage 
life insurance plan and a disability insurance plan 
which are underwritten by the same insurer, then 
if the new insurer consolidates the mortgage life 
plan pursuant to Rule .1 104 or .1105, by offering 
the same coverage at the old premium, then the 
new insurer must also consolidate the disability 
insurance plan at the old premium. 

Statutory Authority G.S. 58-2-40; 58-2-210. 

.1108 DISCLOSURE OF CONSOLIDATION 

TO THE DEPARTMENT OE INSURANCE 



443 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



(a) Except for loan transfer consolidations, the 
new insurer shall notify the North Carolina De- 
partment of Insurance of the intent to execute a 
mortgage insurance consolidation involving 
North Carolina financial institutions at least 30 
days prior to the proposed effective date of the 
new coverage. 

(b) If the consolidation is pursuant to a loan 
transfer, the Department of Insurance shall be 
notified as soon as reasonably possible, but no 
later than 60 days past the date of the loan 
transfer. Direct such notification to: 

North Carolina Department of Insurance 

Life and Health Division 

Post Office Box 26387 

Raleigh, NC 27611 

Statutory Authority G.S. 58-2-40; 58-2-210. 

SECTION .1200 - ACCELERATED BENEFITS 

.1201 PLRPOSE 

The purpose of this Regulation is to regulate 
accelerated benefit provisions of individual and 
group life insurance policies and annuities and to 
provide required standards of disclosure. This 
Regulation shall apply to all accelerated benefits 
provisions of individual and group life insurance 
policies and annuities except those subject to the 
Long-Term Care Insurance Act, issued or deliv- 
ered in this state; for or after the effective date of 
this Regulation. 



Statutory Authority G.S. 58-2-40; 
58-7-15(1); 58-58-1. 



58-3-150; 



.1202 DEFINITIONS 

(a) "Accelerated benefits" covered under this 
Regulation are benefits are payable under a life 
insurance or annuity contract: 

(1) To a policyowner or certificateholder, 
during the lifetime of the insured, in an- 
ticipation of death or upon the occurrence 
of specified life-threatening or catastrophic 
conditions as defined by the policy or 
rider; and 

(2) Which reduce the death benefit otherwise 
payable under the life insurance or annu- 
ity contract; and 

(3) Which are payable upon the occurrence 
of a single qualifying event which results 
in the payment of a benefit amount fixed 
at the time of acceleration. 

(b) "Qualifying event" shall mean one or more 
of the following: 

(1) A medical condition which a duly licensed 
health care provider predicts would result 



in a drastically limited life span as speci- 
fied in the contract, for example, 24 
months or less; or 

(2) A medical condition which has required 
or requires extraordinary medical inter- 
vention, such as, but not limited to, major 
organ transplant or continuous artificial 
life support, without which the insured 
would die; or 

(3) Any condition which usually requires 
continuous confinement in an eligible in- 
stitution as defined in the contract if the 
insured is expected to remain there for the 
rest of his or her life; or 

(4) A medical condition which medical evi- 
dence indicates would, in the absence of 
extensive or extraordinary medical treat- 
ment, result in a drastically limited life 
span. Such conditions may include, but 
are not limited to, one or more of the 
following: 

(A) Coronary artery disease resulting in an 
acute infarction or requiring surgery; 

(B) Permanent neurological deficit resulting 
from cerebral vascular accident; 

(C) End stage renal failure; 

(D) Acquired Immune Deficiency Syn- 
drome; or 

(E) Other medical conditions which the 
Commissioner shall approve for any par- 
ticular filing; or 

(5) Other qualifying events which the Com- 
missioner shall approve for any particular 
filing. 

Statutory Authority G.S. 58-2-40; 58-3-150; 
58-7-15(1); 58-58-1. 

.1203 TYPE OF PRODI CT 

Accelerated benefit riders and life insurance 
policies and annuities with accelerated benefit 
provisions are primarily mortality risks rather 
than morbidity risks. 

Statutory Authority G.S. 58-2-40; 58-3-150; 
58-7-15(1); 58-58-'/. 

.1204 ASSIGNEE/BENEFICIARY 

Prior to the payment of the accelerated benefit, 
the insurer is required to obtain from any 
assignee or irrevocable beneficiary a signed ac- 
knowledgement of concurrence for payout. If 
the insurer making the accelerated benefit is itself 
the assignee under the policy, no such acknowl- 
edgement is required. 

Statutory Authority G.S. 58-2-40; 58-3-150; 
58-7-15(1); 58-58-1. 



6:S NORTH CAROLINA REGISTER July 15, 1991 



444 



PROPOSED RULES 



.1205 CRITERIA FOR PAYMENT 

(a) Lump Sum Settlement Option Required. 
Contract payment options shall include the op- 
tion to take the benefit as a lump sum. The 
benefit shall not be made available as an annuity 
contingent upon the life of the insured. 

(b) Restrictions on Use of Proceeds. No re- 
strictions are permitted on the use of the pro- 
ceeds. 

(c) Accidental Death Benefit Provisions. If any 
death benefit remains after payment of an accel- 
erated benefit, the accidental death benefit pro- 
vision, if any, in the policy or rider shall not be 
affected by the pavment of the accelerated bene- 
fit. 

Statutory Authority G.S. 58-2-40; 58-3-150; 
58-7-15(1); 58-58-1. 

.1206 DISCLOSURES 

(a) Descriptive Title. The terminology "accel- 
erated benefit" shall be included in the descriptive 
title printed on the first page of the policy or 
rider. Products regulated under this Regulation 
shall not be described or marketed as long-term 
care insurance or as providing long-term care 
benefits. 

(b) Tax Consequences. A disclosure statement 
is required at the time of application for the pol- 
icy or rider and at the time the accelerated benefit 
payment request is submitted that receipt of these 
accelerated benefits may be taxable and that as- 
sistance should be sought from a personal tax 
advisor. The disclosure statement shall be 
prominently displayed by a sticker or printed on 
the first page of the policy or rider and any other 
related documents. The suggested disclosure 
statement, to be printed in red bold face type the 
size of which shall not be less than 14 point, is: 

BENEFITS PAID UNDER THIS 
[POLICY, RIDER] MAY BE TAXABLE. IF 
SO, YOU OR YOUR BENEFICIARY MAY 
INCUR A TAX OBLIGATION. AS WITH 
ALL TAX MATTERS, YOU SHOULD 
CONSULT YOUR PERSONAL TAX ADVI- 
SOR TO ASSESS THE IMPACT OF THIS 
BENEFIT. BENEFITS OF THIS 

[POLICY/RIDER] ARE NOT PAYABLE IF 
THE POLICY TO WHICH IT IS AT- 
TACHED IS NOT IN-FORCE. 

(c) Solicitation: 

(1) A written disclosure including, but not 
necessarily limited to, a brief description 
of the accelerated benefit and definitions 
of the conditions or occurrences triggering 



payment of the benefits shall be given to 
the applicant. The description shall in- 
clude an explanation of any effect of the 
payment of a benefit on the policy's cash 
value, accumulation account, death bene- 
fit, premium, policy loans and policy 
hens: 

(A) In the case of agent solicited insurance, 
the agent shall provide the disclosure form 
to the applicant prior to or concurrently 
with the application. Acknowledgement 
of the disclosure shall be signed by the 
applicant and writing agent. 

(B) In the case of a solicitation by direct 
response methods, the insurer shall incor- 
porate the disclosure in the application or 
attach a disclosure form thereto. 

(C) In the case of group insurance policies, 
the disclosure form shall be contained as 
part of the certificate of coverage or any 
related document furnished by the insurer 
for the certificateholder. 

(2) If there is a premium or cost of insurance 
charge, the insurer shall give the applicant 
a generic illustration numerically demon- 
strating any effect of the payment of a 
benefit on the policy's cash value, accu- 
mulation account, death benefit, pre- 
mium, policy loans and policy hens: 

(A) In the case of agent solicited insurance, 
the agent shall provide the illustration to 
the applicant prior to or concurrently with 
the application. 

(B) In the case of a solicitation by direct 
response methods, the insurer shah pro- 
vide the illustration to the applicant at the 
time the policy is delivered. 

(C) In the case of group insurance policies, 
the disclosure form shall be contained as 
part of the certificate of coverage or any 
related document furnished by the insurer 
for the certificateholder. 

(3) Disclosure of Premium Charge: 

(A) Insurers with financing options other 
than as described in Rule .1210(a)(2) of 
this Section shall disclose to the 
policyowner any premium or cost of in- 
surance charge for the accelerated benefit. 
These insurers shall make a reasonable 
effort to assure that the certificateholder 
is aware of any additional premium or 
cost of insurance charge if the 
certificateholder is required to pay such 
charge. 

(B) Insurers shall furnish an actuarial dem- 
onstration to the state insurance depart- 
ment when filing the product disclosing 



445 



6:8 NORTH CAROLINA REGISTER July 15, 1 991 



PROPOSED RULES 



the method of arriving at their cost for the 
accelerated benefit. 
(4) Disclosure of Administrative Expense 
Charge. The insurer shall disclose to the 
policyowner any administrative expense 
charge. The insurer shall make a reason- 
able effort to assure that the 
certificateholder is aware of any adminis- 
trative expense charge if the 
certificateholder is required to pay such 
charge, 
(d) Effect of the Benefit Payment. When a 
policyowner or certificateholder requests an ac- 
celeration, the insurer shall send a statement to 
the policyowner or certificateholder and irrev- 
ocable beneficiary showing any effect that the 
payment of the accelerated benefit will have on 
the policy's cash value, accumulation account, 
death benefit, premium, policy loans and policy 
liens. The statement shall disclose that receipt 
of accelerated benefit payments may adversely 
affect the recipient's eligibility for Medicaid or 
other government benefits or entitlement. In 
addition, receipt of an accelerated benefit pay- 
ment may be taxable and assistance should be 
sought from a personal tax advisor. Each time 
an accelerated benefit option is exercised the 
policyowner and certificateholder shall be given 
an endorsement, rider or schedule page which 
reflects any revisions to cash values, death bene- 
fits, accumulation accounts, premiums, policy 
loans, policy liens and any other values that 
change as a result of the payment or payments. 
When a previous disclosure statement becomes 
invalid as a result of an acceleration of the death 
benefit, the insurer shall send a revised disclosure 
statement to the policyowner or certificateholder 
and irrevocable beneficiary. When the insurer 
agrees to accelerate death benefits, the insurer 
shall issue an amended schedule page to the 
policyholder or notify the certificateholder under 
a group policy to reflect any new, reduced in- 
force face amount of the contract. 

Statutory Authority G.S. 58-2-40; 58-3-150; 
58-7-15(1); 58-58-1. 

.1207 EFFECTIVE DATE OF THE 
ACCELERATED BENEFITS 

The accelerated benefit provision shall be effec- 
tive for accidents on the effective date of the 
policy or rider. The accelerated benefit provision 
shall be effective for illness no more than 30 days 
following the effective date of the policy or rider. 

Statutory Authority G.S. 58-2-40; 58-3-150; 
58-7-15(1); 58-58-1. 



.1208 WAIVER OF PREMIUMS 

The insurer may offer a waiver of premium for 
the accelerated benefit provision in the absence 
of a regular waiver of premium provision being 
in effect. At the time the benefit is claimed, the 
insurer shall explain any continuing premium re- 
quirement to keep the policy in force. 

Statutory Authority G.S. 58-2-40; 58-3-150; 
58-7-15(1); 58-58-1. 

.1209 DISCRIMINATION 

Insurers shall not unfairly discriminate among 
insureds with different or similar qualifying 
events covered under the policy. Insurers shall 
not apply any additional conditions on the pay- 
ment of the accelerated benefits other than those 
conditions specified in the policy or rider. 

Statutory Authority G.S. 58-2-40; 58-3-150; 
58-7-15(1); 58-58-'/. 

.1210 ACTUARIAL STANDARDS 

(a) Financing Options: 

(1) The insurer may require a premium charge 
or cost of insurance charge for the accel- 
erated benefit. These charges shall be 
based on sound actuarial principles. In 
the case of group insurance, the additional 
cost may also be reflected in the experi- 
ence rating. 

(2) The insurer may pay a present value of the 
face amount. The calculation shall be 
based on any applicable actuarial discount 
appropriate to the policy design. The in- 
terest rate or interest rate methodology 
used in the calculation shall be based on 
sound actuarial principles and disclosed in 
the contract or actuarial memorandum. 
The maximum interest rate used shall be 
no greater than the greater of: 

(A) The current yield on 90 day treasury 
bills; or 

(B) The current maximum statutory ad- 
justable policy loan interest rate. 

(3) The insurer may accrue an interest charge 
on the amount of the accelerated benefits. 
The interest rate or interest rate method- 
ology used in the calculation shall be 
based on sound actuarial principles and 
disclosed in the contract or actuarial 
memorandum. The maximum interest 
rate used shall be no greater than the 
greater of: 

(A) The current yield on 90 day treasury 
bills; or 

(B) The current maximum statutory ad- 
justable policy loan interest rate. 



6:S NORTH CAROLINA REGISTER July 15, 1991 



446 



PROPOSED RULES 



The interest rate on the portion of the lien which 
is equal in amount to the cash value of the con- 
tract at the time of the benefit acceleration shall 
be no more than the policy loan interest rate 
stated in the contract. 

(b) Effect on Cash Value: 

( 1 ) Fxcept as provided in Subparagraph (b)(2) 
of this Rule, when an accelerated benefit 
is payable, there shall be no more than a 
pro rata reduction in the cash value based 
on the percentage of death benefits accel- 
erated to produce the accelerated benefit 
payment. 

(2) Alternatively, the payment of accelerated 
benefits, any administrative expense 
charges, any future premiums and any ac- 
crued interest can be considered a lien 
against the death benefit of the policy or 
rider and the access to the cash value may 
be restricted to any excess of the cash 
value over the sum of any other out- 
standing loans and the liens. Future ac- 
cess to additional policy loans could also 
be limited to any excess of the cash value 
over the sum of the lien and any other 
outstanding policy loans. 

(c) Effect of Any Outstanding Policy Loans on 
Accelerated Death Benefit Payment. When 
payment of an accelerated benefit results in a pro 
rata reduction in the cash value, the payment 
may not be applied toward repaying an amount 
greater than a pro rata portion of any outstanding 
policy loans. 

Statutory Authority G.S. 5S-2-40; 58-3-150; 
58-7-15(1); 58-58-1. 

.1211 ACTUARIAL DISCLOSURE AND 
RESERVES 

(a) Actuarial Memorandum. A qualified 
actuary should describe the accelerated benefits, 
the risks, the expected costs and the calculation 
of statutory reserves in an actuarial memoran- 
dum accompanying each filing with the Com- 
missioner. The insurer shall maintain in its files 
descriptions of the bases and procedures used to 
calculate benefits payable under these provisions. 
These descriptions shall be made available for 
examination by the Commissioner or a designee 
upon request. 

(b) Reserves: 

( 1 ) WTen benefits are provided through the 
acceleration of benefits under group or 
individual life policies or riders to such 
policies, policy reserves shall be deter- 
mined in accordance with the Standard 
Valuation Law. All valuation assump- 
tions used in constructing the reserves 



shall be determined as appropriate for 
statutory valuation purposes by a member 
in good standing of the American Acad- 
emy of Actuaries. Mortality tables and 
interest rates currently recognized for life 
insurance reserves by the NAIC may be 
used as well as appropriate assumptions 
for the other provisions incorporated in 
the policy form. The actuary must follow- 
both actuarial standards and certification 
for good and sufficient reserves. Reserves 
in the aggregate should be sufficient to 
cover: 

(A) Policies upon which no claim has yet 
arisen. 

(B) Policies upon which an accelerated 
claim has arisen. 

(2) For policies and certificates which provide 
actuarially equivalent benefits, no addi- 
tional reserves need to be established. 

(3) Policy liens and policy loans, including 
accrued interest, represent assets of the 
company for statutory reporting purposes. 
For any policy on which the policy Hen 
exceeds the policy's statutory reserve li- 
ability such excess must be held as a 
non-admitted asset. 

Statutory Authority G.S. 58-2-40; 58-3-/50; 
58-7-15(1 ); 58-58-). 

TITLE 15A - DEPARTMENT OF 

ENVIRONMENT, HEALTH, AND 

NATURAL RESOURCES 



lyotice is hereby given in accordance with G.S. 
1 SOB- 12 that the Environmental Management 
Commission intends to amend rule(s) cited as 
15A NCAC 2B .0305. 

1 he proposed effective date of this action is April 
1, 1992. 

1 he public hearing will be conducted at 7:00 
p.m. on September 17, 1991 at the County Court- 
house - 2nd Floor. Courtroom 2. 403 West King 
Street, Boone, North Carolina. 

(^ omment Procedures: A 11 persons interested in 
this matter are invited to attend. Comments, 
statements, data and other information may be 
submitted in writing prior to, during or within 
thirty (30) days after the hearing or may be pre- 
sented orally at the hearing. Oral statements may 
be limited at the discretion of the hearing officer. 
Submittal of written copies of oral statements is 
encouraged. For more information contact 



447 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



PROPOSED RULES 



Suzanne H. Keen, Division of Environmental 
Management, P. O. Box 29535, Raleigh, NC 
27626-0535, 919-733-5083. 

CHAPTER 2 - ENVIRONMENTAL 
MANAGEMENT 

SUBCHAPTER 2B - SURFACE WATER 
STANDARDS: MONITORING 

SECTION .0300 - ASSIGNMENT OF STREAM 
CLASSIFICATIONS 

.0305 WATAUGA RIVER BASIN 

(c) The Watauga River Basin Schedule of 
Classifications and Water Quality Standards was 
amended effective: 

(1) August 12, 1979; 

(2) February 1, 1986; 

(3) October 1, 1987; 

(4) August 1, 1989; 

(5) August 1, 1990; 

(6) December 1, 1990; 

(7) April 1, 1992. 

(f) The Schedule of Classifications and Water 
Quality Standards for the Watauga River Basin 
was amended effective April _f 1 C W2 with the re- 
classification of Pond Creek from Classes WS-111 
and C to Classes WS-III Trout and C Trout. 



Statutory Authority G.S. 143-214.1; 
143-215.3(a)(l). 



143-215.1; 



****************** 



No 



otice is hereby given in accordance with G.S. 
150B-12 that the Environmental Management 
Commission intends to amend rule(s) cited as 
15A NCAC 2B .0309. 






1 he proposed effective date of this action is April 
1, 1992. 

1 he public hearing will be conducted at 7:00 
p.m. on September 16, 1 99 1 at the Elkin Recre- 



ation Center, Highway 268 West, Elkin, North 
Carolina. 

Comment Procedures: All persons interested in 
this matter are invited to attend. Comments, 
statements, data and other information may be 
submitted in writing prior to, during or within 
thirty (30) days after the hearing or may be pre- 
sented orally at the hearing. Oral statements may 
be limited at the discretion of the hearing officer. 
Submittal of written copies of oral statements is 
encouraged. For more information contact 
Suzanne H. Keen, Division of Environmental 
Management, P. O. Box 29535, Raleigh, NC 
27626-0535, 919-733-5083. 

CHAPTER 2 - ENVIRONMENTAL 
MANAGEMENT 

SUBCHAPTER 2B - SURFACE WATER 
STANDARDS: MONITORING 

SECTION .0300 - ASSIGNMENT OF STREAM 
CLASSIFICATIONS 

.0309 YADKIN-PEE DEE RIVER BASIN 

(c) The Yadkin- Pee Dee River Basin Schedule 
of Classifications and Water Quality Standards 
was amended effective: 

(1) February 12, 1979; 

(2) March 1, 1983; 

(3) August 1, 1985; 

(4) February 1, 1986; 

(5) October 1, 1988; 

(6) March 1, 1989; 

(7) January 1, 1990; 

(8) August 1, 1990; 
(9} April 1, 1992. 

(g) The Schedule of Classifications and Water 
Quality Standards for the Yadkin- Pee Dee River 
Basin was amended effective April J^ 1992 with 
the reclassification of the North Prong South 
Fork Mitchell River from Class C to Class C 
Trout. 



Statutory Authority G.S. 
143-2I5.3(a)(l). 



143-214.1; 143-215.1; 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



448 



FINAL RULES 



1 he List of Rules Codified is a listing of rules that were filed to be effective in the month indicated. 

J\ules filed for publication in the NCAC may not be identical to the proposed text published pre- 
viously in the Register. Rules filed with changes are noted with ** Amended, ** Adopted. Please 
contact this office if you have any questions. 

/Adopted rules filed by the Departments of Correction, Revenue and Transportation are published 
in this section. These departments are not subject to the provisions of G.S. I SOB, Article 2 requiring 
publication in the N.C. Register of proposed rules. 

U pon request from the adopting agency, the text of rules will be published in this section. 

1 unctuation, typographical and technical changes to rules are incorporated into the List of Rules 
Codified and are noted as * Correction. These changes do not change the effective date of the rule. 



TITLE 10 
DEPARTMENT OF HUMAN RESOURCES 

CHAPTER 45 
COMMISSION FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND 

SUBSTANCE ABUSE SERVICES 

SUBCHAPTER 45H - DRUG TREATMENT FACILITIES 

SECTION .0200 - SCHEDULES OF CONTROLLED SUBSTANCES 

.0201 DEFINITIONS 

As used in this Section, the following terms shall have the meanings specified: 

(7) The term anabolic steroid means any drug or hormonal substance, chemically and 

pharmacologically related to testosterone (other than estrogens, progestins, and corticosteroids) 

that promotes muscle growth, and includes: 

(a) Boldenone: 

(b) Chlorotestosterone (4-chlortestosterone); 

(c) Clostebol; 

(d) Dehydrochlormethvltestosterone; 

(e) Dihydrotestosterone (4-dihvdrotestosterone): 
(t'l Drostanolone: 

(g) Fthvlestrenol: 

(h) riuoxvmesterone: 

(i) FormebuJone (formebolone); 

(j) Mestcrolone: 

(k) Methandienone: 

(J_) Methandranone: 

(ml Methandnol; 



(n) Methandrostenolone: 

(o) Methenolone: 

(p) Methvltestostcrone: 

(q ) Mibolcrone: 

(r) Nandrolone: 

(s) Norethandrolone; 



(t) Oxandrolone: 
(u) Oxvmesterone: 



449 6:8 NORTH CAROLINA REGISTER July 15, 1991 



FINAL RULES 



(v) Oxymetnolone; 

(w) Stanolone; 

(x) Stanozolol; 

(y) Testolactone; 

(z) Testosterone; 

(aa) Trenbolone; and 

(bb) Any salt, ester, or isomer of a drug or substance described or listed in this Paragraph, if that 
salt, ester, or isomer promotes muscle growth. Except such term does not include an anabolic 
steroid which is expressly intended for administration through implants to cattle or other non- 
human species and which has been approved by the Secretary of Health and Human Services 
for such administration. If any person prescribes, dispenses, or distributes such steroid for hu- 
man use, such person shall be considered to have prescribed, dispensed, or distributed an 
anabolic steroid within the meaning of this Paragraph. 
(8) f/4 Any term not defined in this Rule shall have the definition set forth in General Statute 90-87. 

History Note: Statutory Authority G.S. 90-88; 
Eff. June 30, 1978; 
Amended Eff. August 1, 1991; May I, 1990. 

.0203 SCHEDULE II 

(e) Depressants. Unless specifically excepted or unless listed in another schedule, any material, 
compound, mixture of preparation which contains any quantity of the following substances having a 
depressant effect on the central nervous system, including its salts, isomers and salts of isomers when- 
ever the existence of such salts, isomers and salts of isomers is possible within the specific chemical 
designation: 

(1) Amobarbital 2125 

(2) Glutethimide 2250 
[3j £3) Pentobarbital 2270 
[4] <& Secobarbital 2315 

History Note: Statutory Authority G.S. 90-88; 90-90; I43B-147; 
Eff. June 30, 1978; 
Amended Eff. August 1, 1991; August I, 1989; July J, 1989; December 1, 1987. 

.0204 SCHEDULE III 

(c) Depressants. Unless specifically excepted or unless listed in another schedule, any material, 
compound, mixture or preparation which contains any quantity of the following substances having a 
depressant effect on the central nervous system: 

(4} Glutethimid e 2±SQ 

(f) Anabolic steroids. Unless specifically excepted or unless listed in another schedule, any material, 
compound, mixture, or preparation containing any quantity of the following substances, including its 
salts, isomers, and salts of isomers whenever the existence of such salts of isomers is possible within the 
specific chemical designation: 

Anabolic Steroids 4000 

History Note: Statutory Authority G.S. 90-88; 90-91; 143B-147; 
Eff. June 30, 1978; 
Amended Eff. August 1, 1991; December 1, 1987; August 1, 1987; July 1, 1982. 



6:8 NORTH CAROLINA REGISTER July 15, 1991 450 



FINAL RULES 



NORTH CAROLINA ADMINISTRATIVE CODE 

LIST OF RULES CODIFIED 

JULY 1991 



AGENCY 
DEPARTMENT OF ADMINISTRATION 

1 NCAC 4G .0212 

DEPARTMENT OF AGRICULTURE 



ACTION TAKEN 



Amended 



2 NCAC 20B .0403 Repealed 

DEPARTMENT OF ECONOMIC AND COMMUNITY DEVELOPMENT 



4 NCAC 3C .0110 

.0201 

.1601 

18 .0309 

OFFICES OF THE GOVERNOR/LIEUTENANT GOVERNOR 

9 NCAC 2B Executive Order Number 142 

Eff. May 1, 1991 
Executive Order Number 143 
Eff. May 1, 1991 
Executive Order Number 144 
Eff. May 3, 1991 
Executive Order Number 145 
Eff. May 30, 1991 

DEPARTMENT OF HUMAN RESOURCES 



NCAC 



3R 


.0320 

.2002 




20F 


.0101 


.0105 




.0201 


.0202 




.0301 ■ 


.0305 




.0401 ■ 


.0418 




.0501 - 


.0510 


23A 


.0601 - 


.0602 




.0701 - 


.0704 



Amended 
Amended 

Amended 
** Adopted 



Adopted 
** Amended 

Transferred and Recodified 
to 10 NCAC 23D .0101 - .0105 
Eff. May 31, 1991 
Transferred and Recodified 
to 10 NCAC 23D .0201 - .0202 
FIT. May 31, 1991 
Transferred and Recodified 
to 10 NCAC 23E .0101 - .0105 
Eff. May 31, 1991 
Transferred and Recodified 
to 10 NCAC 23E .0201 - .0218 
Fff May 31, 1991 
Transferred and Recodified 
to 10 NCAC 23E .0301 - .0310 
Fff. May 31, 1991 
Recodified from 
10 NCAC 23B .0101 - .0102 
Fff. May 31, 1991 
Recodified from 



^.5/ 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



FINAL RULES 



.0705 - .0707 

23B .0101 - .0102 

.0401 - .0404 

.0406 - .0408 

.23D .0101 - .0105 

.0201 - .0202 

23E .0101 - .0105 

.0201 - .0218 

.0301 - .0310 



24A .0306 
35E .0104 
35F .0002 
41 H .0405 

.0407 

.0408 

.0501 

.0502 

.0601 - .0602 

.0603 

.0604 
42W .0005 
46H .0109 
50B .0101 - .0102 



10 NCAC 23B .0401 - .0404 

Eff. May 31, 1991 

Recodified from 

10 NCAC 23B .0406 - .0408 

Eff. May 31, 1991 

Recodified to 

10 NCAC 23A .0601 - .0602 

Eff. May 31, 1991 

Recodified to 

10 NCAC 23A .0701 - .0704 

Elf. May 31, 1991 

Recodified to 

10 NCAC 23A .0705 - .0707 

Eff. May 31, 1991 

Transferred and Recodified 

from 10 NCAC 20F .0101 - .0105 

Eff. May 31, 1991 

Transferred and Recodified 

from 10 NCAC 20F .0201 - .020: 

Eff. May 31, 1991 

Transferred and Recodified 

from 10 NCAC 20F .0301 - .030: 

Eff. May 31, 1991 

Transferred and Recodified 

from 10 NCAC 20F .0401 - .04U 

Eff. May 31, 1991 

Transferred and Recodified 

from 10 NCAC 20F .0501 - .05U 

Eff. May 31, 1991 

** Amended 

** Amended 

** Amended 

Amended 

** Amended 

Amended 

Amended 

** Amended 

** Adopted 

Adopted 

** Adopted 

Repealed 

** Adopted 

Amended 



DEPARTMENT OF JUSTICE 



12 NCAC 9B .0228 

.0301 

.0302 

.0303 - .0304 

.0305 

.0306 



/Ymended 
** Amended 
Amended 
** Amended 
Amended 
** Amended 



DEPARTMENT OF CRIME CONTROL AND PUBLIC SAFETY 



14A NCAC 



11 .0503 



Repealed 



DEPARTMENT OF ENVIRONMENT, HEALTH. AND NATURAL RESOURCES 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



452 



FINAL RULES 



15A NCAC 



2B 


.0312 

.0313 
.0315 




2D 


.0524 - 
.0901 
.0903 
.0912 


.0525 




.0917- 


.0924 




.0934 




"11 


.0208 




7J 


.0409 




9C 


.1007 




10B 


.0109 
.0114 
.0202 
.0203 
.0209 
.0215 




IOC 


.0103 
.0203 
.0205 






.0304 - 


.0305 




.0407 




10D 


.0002 






.0003 - 


.0004 


10E 


.0004 




16A 


.0804 




18A 


.2616" 

.2618 

.2711 

.2724 

.2801 

.2802 






.2803 - 


.2806 




.2807 






.2808 - 


.2810 




.2811 






.2812- 


.2813 




.2814 






.2815 






.2816 






.2817- 


.2819 




.2820 






.2821 






.2822 






.2823 - 


.2826 




.2827 - 


.2829 




.2830 






.2831 - 


.2833 




.2834 






.2835 




18D 


.0201 
.0206 




19A 


.0102 




REVENl 


E 





Amended 

Eff. August 1, 1991 

** Amended 

** Amended 

** Amended 

.Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Temp. Adopted 

Expires 11-27-91 

Amended 

Amended 

Amended 

** Amended 

** Amended 

** Amended 

** Amended 

** Amended 

** Amended 

** Amended 

Amended 

Amended 

** Amended 

Amended 

* Correction 
** Amended 
** Amended 
** Amended 

* Correction 
** Adopted 
Adopted 

** Adopted 
Adopted 
** Adopted 
Adopted 
** Adopted 
Adopted 
** Adopted 
Adopted 
** Adopted 
Adopted 
** Adopted 
Adopted 
** Adopted 
Adopted 
** Adopted 
Adopted 
** Adopted 
Adopted 
** Amended 
Adopted 

* Correction 



453 



6:S NORTH CAROLINA REGISTER July 15, 1991 



FINAL RULES 



17 NCAC 



6B .0117 

.3503 

.3527 

11 .0103 



Amended 
Amended 
Adopted 
* Correction 



BOARD OF ARCHITECTURE 



21 NCAC 2 .0302 

BOARD OF MEDICAL EXAMINERS 



** Amended 



21 NCAC 32L .0001 
.0005 
.0009 



Amended 
Amended 
Amended 



BOARD OF MORTl ARY SCIENCE 



21 NCAC 34 .0101 -.0122 



.0123 




.0124 




.0125 




.0126 




.0201 - 


.0225 


.0301 - 


.0311 


.0401 - 


.0409 


.0501 - 


.0505 


.0601 - 


.0610 


.0701 - 


.0715 


.0801 - 


.0805 


34A .0101 




.0102 




.0103 




.0104 




.0123 




.0201 





Recodified to 
21 NCAC 34A 
Eff. February 7, 
Recodified to 
21 NCAC 34A 
EfT. February 7, 
Recodified to 
21 NCAC 34A 
Eff. February 7, 
Recodified to 
21 NCAC 34A 
Eff. February 7, 
Recodified to 
21 NCAC 34A 
Eff. February 7, 
Recodified to 
21 NCAC 34B . 
Eff. February 7, 
Recodified to 
21 NCAC 34B 
Eff. February - 7, 
Recodified to 
21 NCAC 34B 
Eff. February 7, 
Recodified to 
21 NCAC 34B . 
Etf. February 7, 
Recodified to 
21 NCAC 34B . 
Eff. February 7, 
Recodified to 
21 NCAC 34B 
Eff. February 7, 
Recodified to 
21 NCAC 34B . 
Eff. February 7, 
Amended 
** Amended 
Amended 
** Amended 
Amended 
** Amended 



.0101 - .0122 
991 



0201 
1991 

0123 
1991 

0202 
1991 

0124 
1991 

0101 - .0125 
1991 

0201 - .0211 
1991 

0301 - .0309 
1991 

0401 - .0405 
1991 

0501 - .0510 
1991 

0601 - .0615 
1991 

0701 - .0705 
1991 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



454 



FINAL RULES 



34 B 



34C 



.0203 
.0612 
.0703 
.0101 
.0201 
.0204 
.0301 



.0105 
.0203 
.0206 
.0306 



Amended 

Amended 

Amended 

Adopted 

** Adopted 

Adopted 

Adopted 



BOARD OF OPTICIANS 



NCAC 



40 



.0205 
.0206 
.0307 
.0314 
.0319 



Amended 
** Amended 
Amended 
** Amended 
** Amended 



KXAMINF.RS OF PLUMBING AND HEATING CONTRACTORS 



21 



NCAC 



50 



.0105 
.0301 
.0309 
.0404 
.0407 
.0411 
.0505 
.1102 



Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 



REAL ESTATE COMMISSION 



NCAC 



58C .0302 



.0501 
.0502 
.0508 
.0511 
.0512 
.0201 



58D 



.0204 
.0206 
.0501 



.0507 
.0510 



Temp. Amended 

Expires 10-02-91 

Adopted 

** Adopted 

Adopted 

** Adopted 

Adopted 

Temp. .Amended 

Expires 10-02-91 

** Amended 

** Amended 

/Amended 



OFFICE OF STATE PERSONNEL 



NCAC ID .1126 

IE .1305 
10 .0201 - .0203 

.0303 - .0304 

.0305 



Amended 
Amended 
** Amended 
** Amended 
Repealed 



455 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



ARRC OBJECTIONS 



1 he Administrative Rules Review Commission (ARRC) objected to the following rides in accord- 
ance with G.S. 143B-30.2(c). State agencies are required to respond to ARRC as provided in G.S. 
143B-30.2(d). 



ADMINISTRATION 

Auxiliary Services 

/ NCAC 4G .0212 - Telefax and Telegraph Proposals 
Agency Revised Rule 

AGRICULTURE 

Plant Industry 

2 NCAC48F .0306 - Collection and Sale of Venus Flytrap 
Agency Revised Rule 

ECONOMIC AND COMMUNITY DEVELOPMENT 

Banking Commission 

4 NCAC 3G .0203 - Expiration and Renewal 

Agency Revised Rule 
4 NCAC 3G .0502 - Annual Report 

Agency Revised Rule 
4 NCAC 3G .0601 - Revocation or Suspension; Hearings 

Agency Revised Rule 

Hazardous Waste Management Commission 

4 NCAC 18 .0309 - Final Site 

Agency Returned Rule Unchanged 

Agency Revised Rule 

EDUCATION 

Elementan' and Secondary Education 

16 NCAC 6C .0207 - Prospective Teacher Scholarship Loans 

ENVIRONMENT, HEALTH, AND NATURAL RESOURCES 

Adult Health 

ISA NCAC 16 A .0804 - Financial Eligibility 

No Response from Agency 

Agency Responded 

No Response from Agency 
ISA NCAC 16A .0806 - Billing the HIV Health Services Program 

No Response from Agency 

Agency Responded 

No Response from Agency 



ARRC Objection 5/16/91 
Obj. Removed 5/16/91 



ARRC Objection 4/18/91 
Obj. Removed 4/18/91 



ARRC Objection 3/21/91 

Obj. Removed 4/18/91 

ARRC Objection 3/21/91 

Obj. Removed 4/18/91 

ARRC Objection 3/21/91 

Obj. Removed 4/18/91 



ARRC Objection 1/18/91 

No Action 2/25/91 

ARRC Objection 4/18/91 

Obj. Removed 5/16/91 



ARRC Objection 6/21/91 



ARRC Objection 1/18/91 
2/25/91 
No Action 3/21/91 

No Action 4/18/91 

ARRC Objection 1/18/91 
2/25/91 
No Action 3/21/91 

No Action 4/18/91 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



456 



ARRC OBJECTIONS 



Coastal Management 

15A NCAC "J .0409 - Civil Penalties 
Agency Returned Rule Unchanged 
Rule Returned to Agency 
Agency Filed Rule with OA H 

Environmental Health 

ISA XCAC ISA .2537 - Appeals 

Agency Responded 

Agency Withdrew Rule 
I5A NCAC ISA .26/6 - Requirements for Employees 

Agency Revised Rule 
15A XCAC ISA .2618 - 

Agency Responded 

Agency Raised Rule 
ISA XCAC ISA .2^11 - 

Agency Responded 

Agency Revised Rule 



Cleaning of Equipment and Utensils 



Toilet Facilities 



ARRC Objection 1118.91 

Xo Action 2:25191 

Xo Action 4 IS 91 

Rule Eff 6 I 91 



ARRC Objection 
Xo A ction 


3 21 91 
4 : /8,91 




5116 91 


ARRC Objection 
Obj. Removed 


4:18-91 
5:16 91 


ARRC Objection 
Xo Action 
Obj. Removed 


3 21 91 

4 IS 91 

5 16. 91 


ARRC Objection 
Xo Action 
Obj. Removed 


3 21 91 

4 18 91 

5 16 91 



HUMAN RESOURCES 



Facility Services 

10 XCAC 3C .0914 - Defs Applicable; Psychiatric Substance Abuse Svcs 

Agency Revised Rule 
10 XCAC 3 J .2401 - Requirement for Operations Manual 

Agency Revised Rule 
10 XCAC 3T .0102 - Definitions 

Agency Revised Rule 
10 XCAC 3T .0603 - Home Health Aide Services 

Agency Revised Rule 
10 XCAC 3T .1101 - Administration 

Agency Revised Rule 
10 XCAC 3T .1112 - Design and Construction 

Agency Revised Rule 
10 XCAC 3T .1114 - Plumbing 

Agency Revised Rule 
10 A CAC 3T .1206 - Hospice Inpatient Fire and Safety Requirements 

Agency Revised Rule 

Individual and Family Support 

10 XCAC 42 B .1201 - Personnel Requirements 

Xo Response from Agency- 
Agency Returned Rule Unchanged 

Agency Filed Rule with OA H 
10 XCAC 42C .2001 - Qualifications of Administrator 

\o Response from Agency 

Agency Returned Rule Unchanged 

Agency Filed Rule with OAH 
10 A CAC 42C .2002 - Qualifications of Supervisor-in-Charge 

Xo Response from Agency 

Agency Returned Rule Unchanged 



ARRC Objection 
Obj. Removed 


4 18 91 
4 IS 91 


ARRC Objection 
Obj. Removed 


4.18 91 
4 18 91 


ARRC Objection 
Obj. Removed 


4 IS. 91 
4 18 91 


ARRC Objection 
Obj. Removed 


4 IS 91 
4 18:91 


ARRC Objection 
Obj. Removed 


4 IS 91 
4 IS 91 


ARRC Objection 
Obj. Removed 


4 18 91 
4/8 91 


ARRC Objection 
Obj. Removed 


4 18 91 
4 18 91 


ARRC Objection 
Obj. Removed 


4 IS 91 

4 IS 91 


ARRC Objection 

Xo Action 
Rule Eff. 


1 18 91 
2.25 91 
3 21 91 
8 01 91 


ARRC Objection 

Xo Action 
Rule Eff. 
ARRC Objection 

Xo Action 


1 IS 91 

2 25 91 

3 21 91 
8 01 91 

1 IS 91 

2 25 91 

3 21 91 



45 ~ 



6:S NORTH CAROLINA REGISTER July IS, 1991 



ARRC OBJECTIONS 



Agency Filed Rule with OAH 
10 NCAC 42C .2006 - Qualifications of Activities Coordinator 

No Response from Agency 

Agency Returned Rule Unchanged 

Agency Filed Rule with OAH 
JO NCAC42C .3301 - Existing Building 

Agency Returned Rule Unchanged 

Agency Filed Rule with OAH 
10 NCAC 42D .1401 - Qualifications of Administrator/Co-Administrator 

Agency Returned Rule Unchanged 

Agency Filed Rule with OAH 

Social Services 

10 NCAC 24 A .0303 - Sell County Board Members/ Social Svcs Comm 
10 NCAC 39D .0202 - Conciliation Procedure 

Agency Revised Rule 
10 NCAC 39D .0408 - Participation Expenses 

Agency Revised Rule 
10 NCAC 39D .0409 - One-Time Work Related Expenses 

Agency Revised Rule 
10 NCAC 39D .0411 - Supportive Svcs/ / Available in Non-JOBs Counties 

Agency Revised Rule 

JUSTICE 

NC Criminal Justice Education 

12 NCAC 9B .0301 - Certification of Instructors 

Agency Revised Rule 
12 NCAC 9B .0302 - General Instructor Certification 

Agency Revised Rule 



Rule Eff 
ARRC Objection 

No Action 
Rule Eff. 
ARRC Objection 
No Action 
Rule Eff 
ARRC Objection 
No Action 
Rule Eff 



8/01/91 

1/18/91 

2/25/91 

3/21/91 

8/01/91 

11/14/90 

12/20/90 

5/01/91 

11/14/90 

12/20/90 

5/01/91 



ARRC Objection 4/18/91 

ARRC Objection 4/18/91 

Obj. Removed 4/18/91 

ARRC Objection 4/18/91 

Obj. Removed 4/18/91 

ARRC Objection 4/18/91 

Obj. Removed 4/18/91 

ARRC Objection 4/18/91 

Obj. Removed 4/18/91 



ARRC Objection 4/18/91 

Obj. Removed 5/16/91 

ARRC Objection 4/18/91 

Obj. Removed 4/18/91 



LABOR 

Migrant Housing 

13 NCAC 16 .020/ - Conduct of Preoccupancy Inspections 

Agency Revised Rule 
13 NCAC 16 .030/ - Provisional Occupancy 

Agency Revised Rule 
13 NCAC 16 .0302 - Provisional Occupancy Denied 

Agency Revised Rule 
13 NCAC 16 .0303 - Inspection of Provisionally Occupied Housing 

Agency Revised Rule 

LICENSING BOARDS AND COMMISSIONS 

Auctioneer's Commission 



ARRC Objection 4/18/91 

Obj. Removed 4/18/91 

ARRC Objection 4/18/91 

Obj. Removed 4/18/91 

ARRC Objection 4/18/91 

Obj. Removed 4/18/91 

ARRC Objection 4/18/91 

Obj. Removed 4/18/91 



21 NCAC4B .0602 - Advertising 
Agency Revised Rule 



ARRC Objection 3/21/91 
Obj. Removed 4/18/91 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



45S 



ARRC OBJECTIONS 



Cosmetic .Art Examiners 



21 NCAC 14F .0010 - Sanitary Rules 

21 NCAC 14G .00 H - Changes in Teaching Staff 

21 XCAC 141 .0302 - Library 

Agency Responded 

Agency Revised Rule 
21 XCAC 14! .0304 - Classroom Work 
21 XCAC 14L .0210 - Effect on Student-Teacher Ratio 

Agency Responded 

Agency Re\ised Rule 

Dental Examiners 

21 XCAC 16C .0310 - Reexamination 

Agency Withdrew Rule 
21 XCAC 16D .0101 - Eligibility Requirements 

Agency Revised Rule 



ARRC Objection 


5; 16191 


ARRC Objection 


5:16 91 


ARRC Objection 


2 25 91 


No Action 


3 21,91 


Obj. Removed 


4 18 91 


ARRC Objection 


5 16 91 


ARRC Objection 


2,25:91 


Xo Action 


3 21,91 


Obj. Removed 


4 18 91 


ARRC Objection 


3 21 91 




4/18/91 


ARRC Objection 


3 21:91 


Obj. Removed 


4 18 91 



Medical Examiners 



21 XCAC 32B .0309 - Personal Interview 
Agency Responded 
Rule Returned to Agency 



ARRC Objection 2 25 91 

Xo Action 3 2191 

5 16 91 



Mortuary Science 



21 XCAC 34C .0102 - Applicability of Statutes 
Agency Withdrew Rule 



ARRC Objection 5 16 91 
5/16/91 



STATE PERSONNEL 



25 XCAC ID .0509 - Se\-erance Salary- Continuation 
Agency's Response Unacceptable 
Rule Returned to Agency 



ARRC Objection 1 18 91 
2 25 91 
4/18/91 



459 



6:S NORTH CAROLINA REGISTER July 15, 1991 



RULES INVALIDATED BY JUDICIAL DECISION 



1 his Section of the Register lists the recent decisions issued by the North Carolina Supreme Court, 
Court of Appeals, Superior Court (when available), and the Office of Administrative Hearings which 
invalidate a rule in the North Carolina Administrative Code. 



10 NCAC 261 .0101 - PURPOSE: SCOPE/NOTICE OF CHANGE IN LEVEL OF CARE 

10 NCAC 261 .0102 - REQUESTS FOR RECONSIDERA TION AND RECIPIENT APPEALS 

10 NCAC 261 .0104 - FORMAL APPEALS 

Thomas R. West, Administrative Law Judge with the Office of Administrative Hearings, declared Rules 
10 NCAC 261 .0101, 10 NCAC 261 .0102 and 10 NCAC 261 .0104 void as applied in Linda Allred, 
Petitioner v. North Carolina Department of Human Resources, Division of Medical Assistance, Re- 
spondent (90 DHR 0940). 

10 NCAC 42W .0003(c) - COUNTY DEPT OF SOCIAL SERVICES RESPONSIBILITIES 
10 NCAC 42W .0005 - REPORTING CASES OF RAPE AND INCEST 

The North Carolina Court of Appeals, per Judge Robert F. Orr, declared Rules 10 NCAC 42YV 
.0003(c) and 10 NCAC 42W .0005 void as applied in Rankin U'hittington. Daniel C Hudgins, Dr. Takey 
Crist, Dr. Gwendolyn Boyd and Planned Parenthood of Greater Charlotte, Inc., Plaintiffs v. The North 
Carolina Department of Human Resources, David Ela/ierty, in his capacity as Secretary of the North 
Carolina Department of Human Resources, The North Carolina Social Services Commission, and C. 
Barry McCartv, in his capacity as Chairperson of the North Carolina Social Services Commission, De- 
fendants [100 N.C. App. 603,"398 S.E.2d 40 (1990)). 

16 NCAC 6D .0105 - USE OF SCHOOL DA Y 

The North Carolina Supreme Court, per Associate Justice Henry E. Frye, held invalid Rule 16 NCAC 
6D .0105 as decided in The State of North Carolina; The North Carolina State Board of Education; and 
Bob Etheridge, State Superintendent of Public Instruction, Plaintiffs v. Whittle Communications and The 
Thomasville City Board of Education, Defendant-Counterclaimants and The Da\idson County Board of 
Education, Defendant- 1 nlervenor and Counter claimant v. The State of North Carolina; The North 
Carolina State Board of Education; and Bob Etheridge, State Superintendent of Public Instruction; and 
Howard S. Haworth; Barbara M. Tapscott; Kenneth R. Harris; Teena Smith Little; W.C. Meekins Jr.; 
Mary B. Morgan; Patricia H. Neal; Cary C Owen; Donald D. Pollock; Prezell R. Robinson; Norma 
B. Turnage; State Treasurer Harlan E. Boyles; and Lt. Governor James C Gardner; in their official 
capacities as members of The North Carolina State Board of Education, Counterclaim Defendants [328 
N.C. 456, 402 S.E.2d 556 (1991)]. 

15 A NCAC 7H .0308 - SPECIFIC USE STANDARDS 

The North Carolina Court of Appeals, per Judge Sidney S. Eagles Jr., held that it was error for the 
Coastal Resources Commission to fail to follow the required notice and comment procedure prior to 
the adoption of temporary rule 15A NCAC 7H .0308(a)(l)(M), but that the CRC followed proper 
procedures when it adopted the text of the temporary rule as a permanent rule [15A NCAC 7H 
.0308(a)(l)(M)|. Conservation Council of North Carolina v. Haste [102 N.C. App. 41 1, 402 S.E.2d 447 
(1991)]. 



6:S NORTH CAROLINA REGISTER July 15, 1991 460 



NORTH CAROLINA ADMINISTRA THE CODE CLASSIFICA TION SYSTEM 



The North Carolina Administrative Code (NCACj has four major subdivisions of rules. Two 
of these, titles and chapters, are mandatory. The major subdivision of the NCA C is the title. 
Each major department in the North Carolina executive branch of government has been as- 
signed a title number. Titles are further broken down into chapters which shall be numerical 
in order. The other two, subchapters and sections are optional subdivisions to be used by 
agencies when appropriate. " 

TITLE/MAJOR DIVISIONS OF THE NORTH CAROLINA ADMINISTRATIVE CODE 



hit: 


DEPARTMENT 


LICENSLNG BOARDS 


CHAPTER 


i 


Administration 


Architecture 


2 


2 


Agriculture 


Auctioneers 


4 


3 


Auditor 


Barber Examiners 


6 


4 


Economic and Community 


Certrfied Public Accountant Examiners 


8 




Development 


Chiropractic Examiners 


10 


5 


Correction 


General Contractors 


12 


6 


Council of State 


Cosmetic Art Examiners 


14 


7 


Cultural Resources 


Dental Examiners 


16 


8 


Elections 


Electrical Contractors 


18 


9 


Governor 


Foresters 


20 


in 


Human Resources 


Geologists 


21 


1 1 


Insurance 


I Iearing Aid Dealers and Fitters 


22 


12 


Justice 


Landscape Architects 


26 


13 


Labor 


Landscape Contractors 


28 


14A 


Crime Control and Public Safety 


Marital & Family Therapy 


31 


1 5A 


Environment, Health, and Natural 


Medical Examiners 


32 




Resources 


Midwifery Joint Committee 


33 


16 


Public Education 


Mortuary Science 


34 


17 


Revenue 


Nursing 


36 


IS 


Secretary of State 


Nursing Home Administrators 


37 


19A 


Transportation 


Occupational Therapists 


38 


20 


Treasurer 


Opticians 


40 


♦21 


Occupational Licensing Boards 


Optometry 


42 


22 


Administrative Procedures 


Osteopathic Examination and 


44 


23 


Community Colleges 


Registration (Repealed) 




24 


Independent Agencies 


Pharmacy 


46 


2^ 


State Personnel 


Physical Therapy Examiners 


4S 


26 


Administrative Hearings 


Plumbing, Heating and Lire Sprinkler 
Contractors 


50 






Podiatry Examiners 


52 






Practicing Counselors 


53 






Practicing Psychologists 


54 






Professional Engineers and Land Surveyors 56 






Real Estate Commission 


58 






Refrigeration Examiners 


60 






Sanitarian Examiners 


62 






Social Work 


63 






Speech and Language Pathologists and 


64 






Audiologists 








Veterinary Medical Board 


66 



Note: Title 21 contains the chapters of the various occupational licensing boards. 



461 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



CUMULA TIVE INDEX 



CUMULA TIVE INDEX 

(April 1991 - March 1992) 



1991 - 1992 



Pages 



Issue 



1 - 44..: 1 - April 

44 - 99 2 - April 

100 - 185 3 - May 

186 - 226 4 - May 

227 - 246 5 - June 

247 - 325 6 - June 

326 - 373 7 - July 

374 - 463 8 - July 



AO - Administrative Order 

AG - Attorney General's Opinions 

C - Correction 

FR - Final Rule 

GS - General Statute 

JO - Judicial Orders or Decision 

M - Miscellaneous 

NP - Notice of Petitions 

PR - Proposed Rule 

SO - Statements of Organization 

TR - Temporary Rule 



ADMINISTRATIVE HEARLNGS 

Hearings Division, 310 PR 

AGRICULTURE 

Plant Industry, 102 PR 

CORRECTION 

Division of Prisons, 35 FR, 87 FR, 209 FR 

ECONOMIC AND COMMUNITY DEVELOPMENT 

Alcoholic Beverage Control Commission, 4 PR 
Community Assistance, 104 PR 
Credit Union Division, 231 PR 

ENVIRONMENT, HEALTH, AND NATURAL RESOURCES 

Coastal Management, 299 PR 

Environmental Management, 197 PR, 271 PR, 447 PR 

Forest Resources, 300 PR 

Health: Epidemiology, 28 PR, 341 PR 

Health Services, 9 PR, 327 PR 

Marine Fisheries, 122 PR 

Wildlife Resources Commission, 84 PR, 170 PR, 198 PR, 301 PR 



6:8 NORTH CAROLINA REGISTER July 15, 1991 



462 



CUMULA TIVE INDEX 



FINAL DECISION LETTERS 

Voting Rights Act, 48, 230, 248, 326 

FINAL RLLES 

List of Rules Codified, 89 FR, 215 FR, 314 FR, 451 FR 

GOVERNOR/LT. GOVERNOR 

Executive Orders, 1, 45, 100, 186, 227, 247, 374 

HUMAN RESOURCES 

Aging, Division of, 72 PR, 422 PR 

Facility Services, 104 PR 

Medical Assistance, 9 PR, 112 PR, 188 PR, 232 PR, 250 PR, 430 PR 

Mental Health, Developmental Disabilities and Substance Abuse Services, 5 PR, 49 PR, 375 PR, 449 FR 

Social Services, 116 PR 

INSURANCE 

Actuarial Services, 119 PR 

Life and Health Division, 430 PR 

Special Services Division, 84 PR 

JUSTICE 

Private Protective Services, 121 PR 
State Bureau of Investigation, 250 PR 

LICENSING BOARDS 

Architecture, Board of, 30 PR, 232 PR 

Certified Public Accountant Examiners, 201 PR 

Medical Examiners, Board of, 304 PR, 363 PR 

Nursing, Board of, 305 PR 

Pharmacy, Board of, 201 PR 

Physical Therapy Examiners, Board of, 33 PR, 363 PR 

Practicing Psychologists Examiners, 203 PR 

Real Estate Commission, 171 PR 

PUBLIC EDUCATION 

Elementary and Secondary, 29 PR, 199 PR, 303 PR 

REVENUE 

Individual Income Tax Division, 234 FR 
Property Tax Commission, 210 FR 

SECRETARV OF STATE 

Securities Division, 85 PR 

STATE PERSONNEL 

State Personnel Commission, 172 PR, 364 PR 

TRANSPORTATION 

Division of Motor Vehicles, 213 FR 



463 6:8 NORTH CAROLINA REGISTER July 15, 1991 



NORTH CAROLINA ADMINISTRATIVE CODE 

The full publication consists of 53 volumes, totaling in excess of 15,000 pages. It is supplemented monthly 
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2 

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6 

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9 

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10 
10 
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